SCPC Applauds House Oversight and Accountability Committee Chair James Comer for Launching Investigation into PBM Practices

DATE: March 10, 2023

The Senior Care Pharmacy Coalition (SCPC), the only Washington-based organization exclusively representing the interests of long-term care (LTC) pharmacies, applauds House Committee on Oversight and Accountability Chairman James Comer (R-KY) for launching an investigation into pharmacy benefit managers (PBMs) and their tactics that are harming patient care and increasing costs for many patients, including millions of Americans in need of LTC and related services.

The launch of this investigation is a significant step forward in addressing the abusive and anti-competitive business practices of PBMs and their corporate masters, and at last protecting consumers and independent LTC pharmacies. Chairman Comer’s actions further validate SCPC’s continued calls for more transparency into the exchanges between key entities that drive up prescription drug costs. To this end, SCPC provided a detailed analysis of the impact on LTC pharmacies and the millions of Americans who need LTC and related services to the Federal Trade Commission (FTC) last year when solicited for public comments.

As middlemen between the manufacturers, pharmacies and consumers, PBMs are known to impose anti-competitive barriers that restrict patient access to high-quality care and services from specially trained health care professionals like those at LTC pharmacies. Only three PBMs dominate the pharmaceutical market—controlling 80% of the total prescription market—and for LTC pharmacies this market concentration is even higher. Each PBM is a part of a larger health care conglomerate that collectively dominate the markets for health insurance, prescription drug coverage, retail pharmacy, mail order pharmacy, and specialty pharmacy, and owns a significant share of the LTC pharmacy market.

LTC pharmacies have a unique perspective on PBM issues because they serve patients with LTC needs, a group that is not confined to LTC facilities and that relies overwhelmingly on Medicare to pay for their drugs. They rely heavily on prescription drugs, with older adults who need LTC averaging 12-14 prescription medications a day. These individuals are medically complex, suffer multiple chronic conditions, have extensive impairments in daily activities, and benefit from the enhanced services LTC pharmacies provide. Unfortunately, PBM practices often prevent this group from accessing the enhanced services that LTC pharmacies provide.

SCPC commends Chairman Comer and the House Committee on Oversight and Accountability for initiating this investigation and looks forward to supporting the Committee in order to hold PBMs accountable for their unfair and anti-competitive practices that negatively impact the health of many Americans, especially patients with LTC needs who are most vulnerable.