The National Community Pharmacists Association (NCPA) has called upon the Department of Government Efficiency (DOGE) to scrutinize pharmacy benefit managers (PBMs) for potential waste, fraud, and abuse impacting healthcare programs.
In a letter addressed to Rachel Riley, senior adviser for the U.S. Department of Health and Human Services, NCPA CEO B. Douglas Hoey expressed concerns regarding the dominance of PBMs. "The increasing dominance of PBMs poses a significant threat to consumers’ convenient access to prescription medications and pharmacy services, while at the same time charging taxpayers excessively and draining limited health care resources in public health programs like Medicare Part D, Medicaid, Tricare, and the Federal Employees Health Benefit Plan (FEHBP)," Hoey stated.
The letter highlights that CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealthcare’s OptumRx collectively control a vast majority of prescriptions in the United States, using this dominance to marginalize smaller competitors and influence patient pharmacy choices. Hoey further stated, “PBMs’ anticompetitive practices, opaque reimbursement models, and restrictive contract terms have created an environment in which they can use their overwhelming market power to steer patients away from their competitors to their own pharmacies and pay themselves higher prescription reimbursement rates.”
Hoey's concerns extend to the substantial government subsidies allocated to these insurer-PBMs, an issue of particular interest to DOGE. “This wasteful use of taxpayer dollars is one in which DOGE should have a particularly strong interest,” Hoey added. NCPA accused PBMs of resisting transparency and reform efforts due to their potent influence over drug pricing and consumer guidance.
As Congress deliberates incorporating PBM reforms into spending bills, Hoey suggests cooperation between DOGE and the Centers for Medicare & Medicaid Services to refine the Medicare Drug Price Negotiation Program. He expressed anxiety about financial strains on pharmacies, emphasizing a potential loss of vital revenue due to underpayments.
Hoey cited evidence of anticompetitive practices disclosed by the Federal Trade Commission and the House Oversight Committee, which allegedly contribute to increased drug costs and diminished competition. Additionally, he mentioned President Trump’s previous statements against PBMs, advocating for a reduction in their influence.
NCPA remains hopeful for impending legislative reforms addressing PBM practices, aiming to alleviate the burden on taxpayer-funded health insurance programs. “We are optimistic that Congress will act soon to pass comprehensive PBM reform legislation, but we believe there is more that the agencies can do to address PBM abuses that put a strain on taxpayer-funded health insurance programs,” Hoey concluded.
The National Community Pharmacists Association, established in 1898, represents over 18,900 pharmacies nationwide, employing more than 205,000 individuals. They advocate for accessible healthcare and community-focused pharmacy services.
For more details, visit www.ncpa.org.
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