National Community Pharmacists Association CEO B. Douglas Hoey testified before the House Energy and Commerce Committee’s Subcommittee on Health, urging Congress to address what he described as harmful effects of consolidation among large pharmacy benefit managers (PBMs) in the health care sector.
In his written statement, Hoey pointed out that since his last appearance before the committee in 2017, PBMs’ influence has increased due to ongoing mergers and acquisitions. He cited several examples: “CVS Health acquired Aetna, Cigna acquired Express Scripts, UnitedHealth Group’s OptumRX acquired Change Healthcare and UnitedHealth Group is now the largest employer of physicians in the country,” he wrote. Hoey also noted a reduction of more than 4,100 pharmacies over four years. He stated, “Horizontal and vertical consolidation in health care has not produced the efficiencies and consumer price reductions Americans were promised. Instead, it has created worse outcomes, higher costs, and rationing access for patients, employers, and taxpayers. It has created an uneven playing field for competitors and has directly harmed access to independent pharmacies.”
Hoey highlighted practices such as patient steering and use of group purchasing organizations as factors that raise costs while reducing patient access and quality of care. He said these tactics have led to punitive audits and inadequate reimbursement for competing pharmacies.
He expressed support for recent actions by Congress and the Federal Trade Commission but recommended further steps including breaking up consolidated entities, banning patient steering, requiring transparent pharmacy reimbursement models, prohibiting spread pricing, and speeding up implementation of new PBM contract rules. According to Hoey: “PBMs have historically adapted their corporate structures and shifted operational activities (including overseas entities) in ways that reduce transparency and frustrate oversight/reform efforts.”
The National Community Pharmacists Association represents more than 18,900 community pharmacies employing over 235,000 people across the United States. The organization advocates for local pharmacies as accessible health care providers within their communities.
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