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Amid intensifying scrutiny of pharmacy benefit managers, a group of House Republicans is urging the U.S. Government Accountability Office to investigate the role these controversial middlemen play in the opaque pharmaceutical pricing system.

In a June 17 letter, the lawmakers cite increasingly familiar questions about the interactions between pharmacy benefit managers and drug companies, commercial health plans, state Medicaid programs, and pharmacies. At issue are various rebates and fees that pharmacy benefit managers charge, which critics say add to the cost of prescription drugs due to a lack of transparency.


They also reiterated concerns about competition, given that the three largest pharmacy benefit managers – CVS Caremark, Express Scripts and OptumRx — control an estimated 79% of the market. Moreover, each one is also associated with a major commercial health plan and specialty pharmacy, which provides incentives to steer patients to use the affiliated services.

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