▶ 0:07:45The subcommittee on health, employment, labor, and pensions will come to order. Today's hearing will examine pharmacy benefit managers or PBMs and the lucrative relationships they have with brokers and advisers who are trusted by employers for group health plan design and administration.
▶ 0:08:05PBMs act as third-party intermediaries uh in a drug supply chain that runs from drug manufacturers through employment retirement security act 1974 Orisa plans to about 90 million patients in this role PBM's will wield enormous power over pricing distribution and whether a drug is accessible through a p uh patients health plan through a complex and often opaque system of rebates admin administrative fees
▶ 0:08:35and pricing mechanisms. PBMs are driving up costs, creating huge financial returns for themselves while pres while while prescription drug costs rise for the American worker and their employers. In the midst of this complexity and perhaps because of it, many employers hire consultants or brokers to design their health care plans and help choose and monitor a PBM.
▶ 0:08:59Some of these brokers and consultants may be steering employers and sponsors to a particular PBM that in turn provides consultants and brokers with significant kickbacks. All while the broker or consultant poses as a neutral trusted adviser to the employer. There is little transparency around PBM pricing and practices making it diffult difficult to understand the full scope of these financial arrangements. Addressing this lack of transparency is critical to lowering cost.
▶ 0:09:28The committee is taking steps to do just that. A key feature of President Trump's great health care plan includes ending deceptive practices that enable PBMs to pay kickbacks to brokers and consultants which raise drug prices. Building on this effort, my bill bill, the PBM kickback prohibition act prohibits PBMs from paying kickbacks to brokers or consultants in exchange for steering health plans toward preferred PBMs.
▶ 0:09:57Today we will hear from witnesses about the reliance on brokers and consultants in designing employer sponsored health plans. And we'll also hear how compensation arrangements tied to PBM's threaten the independence of their advice. Bottom line, Americans are still stuck with skyrocketing health care cost after years of failed Biden Harris policies. Now, the committee and the Trump administration are taking action to bring down cause, restore accountability, and put patience, not special interest, in charge.
▶ 0:10:27With that, I'll yield to uh my friend, our ranking member, Mr. Sier, for his opening
▶ 0:10:34Thank you, Mr. Chairman. I want to thank all the witnesses for being here. Um, and I just it's this is something I think we can all agree on. This is where the Americans struggling daytoday to be able to pay for their fixed costs so they've got a little extra money to take their kids on a vacation or just spend some time to go out to eat. Uh PBMs just suck money out of average Americans workers uh pockets. There was a point to them at one point in terms of uh improving efficiency.
▶ 0:11:05But in the most costly health care system in the world for a developed country, 18% of GDP with the worst outcomes, this is a perfect example, Mr. Chairman, of something you and I have talked about often that Democrats and Republicans should be able to come together on. It's wasteful. Well, let's be efficient and let's save Americans a little extra money so that they can get out of the stress they feel where they've got to worry about gas prices and just paying for lunch for their kids.
▶ 0:11:34Here's a perfect example of something that does no good for really anyone to speak of other than the people who make money off of it. So here's a real opportunity for employers and for working people to get a real benefit. PBMs are, as I just said, a huge part of the problem and our inefficiencies. Americans should be embarrassed by this and outraged.
▶ 0:11:58Unfortunately, their business practices are notoriously opaque, leaving employers and workers the inability to even get an idea of what they cost. I'm proud to say that we have done good bipartisan work on this committee in this subcommittee to get a real start on PBMs and improving transparency and efficiency. My colleague, the gentleman from Connecticut, uh Mr. Courtney, introduced the bipartisan hidden fee disclosure act to shed light on fees charged by PBMs.
▶ 0:12:27uh and thirdparty administrators and other service providers. We have also worked in a bipartis bipartisan manner to craft legislation requiring detailed disclosures of PBM rebates, fees, and other information to group health plans. I am pleased to see that portions of both bills were included in February spending legislation.
▶ 0:12:47I hope that these reforms as well as the important rule proposed in January by the Department of Labor can lead to progress that reduces conflicts of interest and inefficiencies in the PBM model. We can't wait. There's real urgency in my perspective to fixing this and get rid of the fraud in PBM model. But demanding transparency from PBMs alone will not solve the crisis of skyrocketing drug prices.
▶ 0:13:15We cannot get a handle on this issues issue until we address the elephant in the room big pharma. In 2022, Democrats over uh unfortunately unanimous opposition from our colleagues and we'll hope to change that took a historic step forward by creating the Medicare drug price negotiations program. In just the first two years of that program, lower prices have already been negotiated for 25 drugs that account for more than 90 billion dollars in spending.
▶ 0:13:45It is now time for Congress in a bipartisan way, in my view, and I'll work uh every day to work with you, Mr. Chairman, in a bipartisan way to lower cost for Americans with PBMs and negotiate competitive prices for the market to work the way other developed countries have. the EU, Australia, New Zealand. I've talked about my own personal experience with the with the drug that keeps me alive as a survivor of stage four leukemia.
▶ 0:14:15Much of the investment in that drug came from taxpayers at the Department of Defense over the last 60 years and uh in NIH. Really remarkable. I'm alive today because of this research. But Johnson and Johnson and having talked spoken directly with the CEO of Johnson and Johnson over that the oversight committee and we brought him to testify. It's fair to get a reasonable rate of return.
▶ 0:14:38We encourage that for the private sector, but let's be honest about where much of the private the the the primary investment research came from American taxpayers and the brilliant people in the Department of Defense and the NIH and DARPA and ARPA.
▶ 0:14:54The legislation we've introduced on PBMs goes to the root of the problem u both for PBMs and the other issue about big pharma in this instance with PBMs in this hearing targeting middlemen who offer little value to employers or to workers. Thank you, Mr. Chairman. I yield back.
▶ 0:15:14I thank the ranking member for yielding and for your uh cooperation and uh our working together and collaboration. Thank you so much. Uh, pursuant to committ committee rule 8C, all members who wish to insert written statements into the record may do so by submitting them to the committee clerk electronically in Microsoft Word format by 5:00 p.m. 14 days after this hearing.
▶ 0:15:36And without objection, the hearing record will remain open for 14 days to allow such statements and other extraneous materials noted during the hearing to be submitted for the official hearing record. I will now turn to the introduction of our four distinguished witnesses. Our first witness is Mr. James Gilfan, president and CEO of the Orisa Industry Committee in Washington DC. Our second witness is Mrs.
▶ 0:16:03Chris Deacon, principal and founder of Versan Consulting in Moresville, New Jersey. Our third witness is Dr. Mariana SoCal, associate professor of public uh health policy and management, John Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Our last witness is Miss Hannah Anderson, director of healthy American policy and senior director of policy at AFPI in Washington DC.
▶ 0:16:30We thank the witnesses for being here today and we look forward to your testimony. Pursuant to committee rules, I would ask that you each limit your oral presentations to a threeminut summary of your written statement. As committee members have many questions for you, the clock will countdown from 3 minutes. Pursuant to committee rule 8 and committee practice, however, we will not cut off your testimony until you reach the five minute mark.
▶ 0:16:54I would also like to remind the witnesses to be aware of your responsibility to provide accurate information to this subcommittee. I will first recognize Mr. Gilfan for your
▶ 0:17:07Thank you, Mr. Chairman, Ranking Member Dier, and members of the subcommittee for the opportunity to testify today. I'm James Gelfin, president and CEO of the Orisa Industry Committee, or ERIC, the only national association that exclusively represents large employers regarding health, retirement, and compensation policies. Our Fortune 100 member companies employ people in every state and are the backbone of the employer sponsored insurance system that provides health benefits to over 160 million American workers and their families.
▶ 0:17:38ERIC member companies provide coverage through self-insured health benefit plans. So when an employee fills a prescription, goes to the doctor, goes to the emergency room, it's not the insurance company paying the bill, it's the employer and the employee. On average, ERIC's member companies pay about 80% of health care costs for their employees and families. Providing affordable access to health care is a responsibility employers take seriously.
▶ 0:18:03And Eric's member companies are committed to pursuing value for employees, selecting the very best vendors, the best plan design, and the lowest fees to maximize the benefits for our plan enroles. And one way that employers seek to be responsible managers of benefit plans is by relying on advice and counsel from outside experts such as brokers and consultants.
▶ 0:18:25Employers retain these experts to help advise on plan design, to construct requests for proposals, to choose vendors such as thirdparty administrators and PBMs, and to oversee the conduct and performance of those vendors through audits, evaluations, and ongoing comparisons with market research and other metrics.
▶ 0:18:45Unfortunately, we have been made aware of a troubling practice where in some, not all, but some brokers, consultants, and advisers who are supposed to advise employer plans are actually paid what appear to be kickbacks from the very vendors they are supposed to be sorting through and fairly evaluating. These arrangements create clear conflicts of interest and undermine employers ability to make informed, cost-effective decisions for our beneficiaries.
▶ 0:19:15The kickbacks in the form of fees, commissions, overrides, and even per prescription cost add-ons drive costs higher and have the potential to prioritize revenue over value in the vendor selection process. This conflict of interest should be addressed so that employers can fully trust the advice and counsel they receive in administering employee benefits. We appreciate Congress's investment in PBM transparency and the administration's recent regulatory action.
▶ 0:19:45The PBM kickback prohibition act introduced by Chairman Allen would prohibit PBMs from providing kickbacks or referral fees to intermediaries in exchange for steering business to them. We believe that this legislation would restore trust, accountability, and integrity to the process and lead to more affordable health care for working families.
▶ 0:20:06We look forward to working with you to advance targeted reforms like this that lower costs and align incentives so that health benefits serve patients and workers, not middlemen. Thank you. I welcome any questions.
▶ 0:20:21Thank gentlemen for yielding. Now recognize Mrs. Deacon for your
▶ 0:20:26Thank you chairman, ranking member, and members of the subcommittee. I've run one of the largest commercial health plans in the country, written and negotiated PBM contracts, run procurements, and am familiar with the financial arrangements and conflicts that drive this system. I am here to tell you plainly that the current kickback pay-to-play model is failing employees, employers, [snorts] and taxpayers.
▶ 0:20:53One of the primary functions of broker consultants is to assist the group health plan in procuring PBM services. Unbeknownst to employers, payment to the consultant is often a precondition of even bidding on PBM contracts. It is not uncommon to see question one of an RFP. Do you agree to pay big box broker $50,000 annually over the life of the contract?
▶ 0:21:20Employers never even get to see potential biders that have agreed not that have agreed not to pay or paytoplay. Not only are these conditions not disclosed to employers, they are often told that these questionnaires and bidding documents are proprietary, confidential, and cannot be shared with the client. Beyond procurement, there are ongoing payments between PBMs and consultants related to the group health plans business.
▶ 0:21:46In one example I share in my written testimony, CVS Caremark agreed to pay Gallagher $2.50 50 cents per retail prescription and $7 per male and specialty prescription filled by the group health plan members. This dynamic does not reward reducing cost, nor does it reward reducing utilization.
▶ 0:22:08It rewards increased volume and handsomely rewards increased volume filled through those channels that generate the highest profits for PBMs and their affiliates. This dynamic rewards the status quo and it acts to dissuade consultants from engaging in procurements or oversight that may be financially disruptive to legacy PBM arrangements. I do want to be very clear, not every consultant operates this way.
▶ 0:22:38Those that are truly independent, those that compete on transparent pricing and aligned incentives will not be disadvantaged by this legislation. they will benefit from it and more importantly their clients will benefit. The same is true for PBMs. Those that are willing to compete based on pricing and their product, not on their ability to support these types of financial arrangements will win. The PBM kick kickback prohibition act addresses a specific and important problem.
▶ 0:23:08Employers are fiduciaries under Orisa and they are expected to act in the best interest of the plan and plan participants. But today they're making decisions involving hundreds of millions billions of dollars without clear visibility into how incentives are structured and without the power or leverage to change them. This bill is a necessary first step towards correcting that. Thank you and I welcome any I thank gentle lady for yielding.
▶ 0:23:39Uh next I recognize professor SoCal for your testimony.
▶ 0:23:44Thank you so much chairman, ranking member, and members of the subcommittee. It's a great honor to be speaking with you today. I'm Mariana SoCal, an associate professor at the Johns Hopkins Bloomberg School of Public Health. My research focuses on improving access and affordability of prescription drugs and I'm speaking today on my own behalf. My views do not reflect the views of Johns Hopkins University. For several years, I've been working with large employer organizations such as the Orisa Industry Committee and the Purchaser Business School Group on Health.
▶ 0:24:14I have witnessed firsthand how the high cost of prescription drugs weighs heavily on American employers. Over half of all Americans obtain coverage, including for drugs, through their employer. Three out of four employers report persistent growth in costs in recent years. And the high price of prescription drugs has driven much of this increase. The problem is that many Americans cannot afford the drugs they need even if they have insurance because of high prices.
▶ 0:24:42Commercial plans and self-insured employers typically hire a pharmacy benefit manager, a PBM, to manage their drug benefit. The PBM helps determine the drugs that the plan will cover and negotiate prices with drug manufacturers. Therefore, the plan PBM plays a central role in determining plan's pharmacy spending. the therapeutic options available to patients and the out-ofpocket costs.
▶ 0:25:05Today, the three large PBMs that collectively control 80% of the US market are vertically integrated with some plans, pharmacies and providers in this market that is characterized by the lack of transparent information. Plans that are not integrated must select of PBM and often turn to brokers and consultants for help with that. However, these consultants often get paid by the PBMs that ultimately get selected.
▶ 0:25:32This can create a conflict of interest, incentivizing some consultants to prefer the PBM that pays the most, not necessarily the PBM that provides the best option for the plan. Through initiatives such as the PBM kickback prohibition act, Congress should prohibit such payments to avoid this conflict of interest.
▶ 0:25:50Now, while this and other recent reforms have brought greater transparency onto PBMs, and employers may have more visibility into what they're paying, the laws do not address the high drug prices in this market. And this is an important gap. The current PBM business model incentivizes the use of big rebates to which drug manufacturers have responded by raising list prices.
▶ 0:26:14Patients pay based on these high prices when they're paying cash, when they're in the deductible phase, or when they must pay a percentage of the drug cost to get their drug. The Medicare program received a series of reforms to directly address high drug prices through the passage of the Inflation Reduction Act, the IRA. Starting in 2022 23, Medicare beneficiaries began receiving IRA protections, out-ofpocket caps, inflation rebates, and the first drug selected for drug price negotiation.
▶ 0:26:43Employers, however, receive none of these protections and they had their prescription drug costs grow by 8.4% in that period. Through initiatives such as HR 6166, Congress should consider extending these protections to the over 160 million Americans that obtain health coverage through their employers.
▶ 0:27:05Expanding Medicare negotiated prices to the commercial market would allow commercial insurers and self-insured employers to access transparent negotiated prices did that in 2026 were up to 90 79% lower than the list price. This can reduce the contribution of rebates in coverage decisions, increase transparency and over lower overall costs, including for beneficiaries.
▶ 0:27:29Extending inflation rebates to commercial markets would also help mitigate the increasing trend of drug companies raising prices to maximize rebates when negotiating with a PBM. PBM reform is urgently needed throughout our healthcare system, but in isolation, it is not sufficient to provide the needed relief for employers and patients. Lowering prescription drug prices in the commercial market is imperative.
▶ 0:27:55Lower healthare costs can also contribute to making American workers and companies more competitive in the global market. Thank you so much and I look forward to answering any questions you may have. I thank the gentle lady for yielding. Lastly, I recognize uh Mrs. Anderson for your testimony.
▶ 0:28:15Good morning, Chairman Allen, Ranking Member Dier, and members of the subcommittee. Thank you so much for this opportunity to testify on the president's great healthcare plan. My name is Hannah Anderson and I lead healthy America policy at the America First Policy Institute. And I just want to say a special thanks to getting to uh be before you today with friends like Jeanie and Dan who I worked with on uh legislation like this in the past. Um 136 million Americans have employer sponsored healthcare.
▶ 0:28:43These patients rely on their employers or unions to provide them with health benefits as part of their compensation package. And under Orisa, they have the authority to provide the most tailor made health benefits for their employee population. Just like any other industry, they often turn to brokers and consultants to help them offer a more competitive benefits package to potential employees. Ideally, these independent consultants are able to stretch the company's dollar further, uh, getting lower cost, greater coverage, and better health for the employee population.
▶ 0:29:12However, that's not been the case. The problem is that those consultants they rely on to select PBMs are not always independent. reports have found that they often take more in kickbacks from the PBMs than they do payments by the plan sponsors. Uh, and my fellow witnesses have acknowledged this and and kind of discussed this at length, but it's really disappointing because it seems that instead of placing the plan sponsor with the best PBM, it's more about placing the PBM with the plan sponsor who pays the consultant the most. And so, this isn't theoretical.
▶ 0:29:42It's affecting millions of Americans right now. One example comes to mind. Uh, a patient at J&J found out that their insurance was paying $10,000 for a drug that was available for $28 if they only paid cash at the pharmacy counter. In their lawsuit, they claimed that it was because the broker AON steered J&J to Express Scripts, which was paying AON referral fees. That's so disappointing. Um, and these conflicts don't stop at consulting fees.
▶ 0:30:10PBMs have inserted gag clauses that prevent pharmacists from telling patients the cash price of the drug and use rebate aggregators to hide rebate revenue. This has all also hurt the independent and community pharmacy. Thanks to President Trump and this committee, we've made real progress. The 2021 appropriations bill required disclosure of broker and consultant compensation. The appropriations bill of this year extended that to PBM remuneration.
▶ 0:30:37And in January 2026, the Department of Labor proposed a PBM disclosure rule pursuant to the president's executive order putting Americans first on drug pricing. These are meaningful steps, but as we've heard, disclosure alone is not enough when the underlying financial perverse incentives still exist. So, Chairman Allen's PBM kickback prohibition act takes the next step to codify President Trump's great healthcare plan into law.
▶ 0:31:01This legislation would amend Orisa to directly prohibit PBMs from paying referral fees to brokers, consultants, or adviserss in exchange for directing employer health plan business to the PBM. It ends the structural incentive, not just requires the disclosure of it. Patients first is not a tagline. It's a legal obligation under Orisa and the president's great healthcare plan makes that real. Thank you and I look forward to your questions.
▶ 0:31:27I thank the gentle lady for yielding. Under committee rule nine, we will now question witnesses under the fiveminute rule. I will recognize myself for five minutes. Mr. Gilin, your testimony states that one way employers seek to responsibly manage costs is by relying on advice from outside experts.
▶ 0:31:49Could you discuss whether these relationships between the plan sponsor and health plan fidiciaries on the one hand and brokers and consultants on the other are typically long-standing relationships?
▶ 0:32:01Absolutely, Mr. Chairman. Many employers maintain long-standing relationships with their brokers and consultants. They spend years working together to develop and refine benefit plans. They experiment with different vendors and point solutions and evaluate different options to try to maximize value. So these are relationships that often can span many years and the broker and consultant may have a very deep familiarity with a particular employee benefits plan.
▶ 0:32:25Why should a plan sponsor or help plan fidiciary be able to trust their broker or consultant to give recommendations that are in the best interest of the
▶ 0:32:35Well, in short, they work for us. So, you know, earlier this year, Congress fixed a terrible conflict of interest with PBMs. The PBMs were supposed to work for the employer and fight for us against big pharma to lower drug costs. But it turned out they were actually paid by big pharma, right? And they were using us to play both sides and to maximize their revenue.
▶ 0:32:55So now we are faced with a very similar conflict of interest wherein the brokers and consultants that are expected to advise us and be advocates for the employers are instead potentially being paid by the vendors they're supposed to be arguing against and negotiating down. Um, we do think that brokers and consultants provide an incredibly valuable service. They have expertise that employers simply don't have and can't afford to include in their benefits department. But we've got to be able to trust them.
▶ 0:33:24We've got to be able to rely on them because we are fiduciaries. Employers have to act in the best interest of employees. We have to do our best to control costs and we need accurate and unbiased advice if we're going to do that.
▶ 0:33:36Thank you, Miss Deacon. Uh your written testimony states that employers and help plan sponsors rely on brokers and consultants to advise them on which PBM to select and how those contracts are structured. Could you discuss whether these employers and plan sponsors trust the broker to render advice that is in the best interest of plan sponsors goal of design designing a robust but affordable benefit structure?
▶ 0:34:03um you know similar to my colleague it many employers do trust them to um counsel on these decisions and in many cases you know they have to in some cases the trust is warranted but this PBM environment is highly technical and employers don't often have the internal staff or resources to evaluate things like rebate structures and formulary strategies specialty pharmacy economics um but you know in despite the increased disclosure as
▶ 0:34:33discussed the 408b2 disclosures um this increased disclosure of the market it had has been wo woefully insufficient um and it will continue to be woefully insufficient so long as consultants continue to get paid by the PBM or the bidding um bidding PBM including on per claim basis or um compensation I mean the conflict between the employer's expectation of of getting the best
▶ 0:35:04um PBM for their plan and independent advice and the consultants in economic incentives on the other hand are completely at odds. Um so until this is solved that trust um is very difficult.
▶ 0:35:16How can a plan sponsor learn if a broker or consultant has a financial incentive outside uh incentive that would impair the broker's independence?
▶ 0:35:26Well, I mean certainly they should ask and under 408 B2 they they must ask, right? Um the problem is again I have seen firsthand where those disclosures are requested and then consultants are not being fully transparent in what those fees are and again when the underlying economics of the relationship like percript fees increased utilization at higher profitable channels for the PBM when the employer isn't able to actually see those underlying economics
▶ 0:35:56either sometimes these very like highle disclosures do not do not adequately inform the employer as to what the economic incentives of the consultant are. So, um disclosures alone here are really insufficient.
▶ 0:36:12Miss Anderson, do you have any comment on that? 27 26 seconds. Okay.
▶ 0:36:18No, sir. Only just to say that, you know, this is all part of an employees compensation package. So all of this money, even though it's it's leaking to other parts of the health system, at the end of the day belongs to the patient or employee that is benefiting from the employee welfare benefit plan, similar to 401ks and all of the other benefits employers provide.
▶ 0:36:42I [clears throat] am out of time and so uh Miss Lee from Pennsylvania, it's your time to answer uh ask questions.
▶ 0:36:50Thank you, Mr. Chairman. Uh pharmacy benefit managers have an unbelievable amount of control over our healthcare. They control drug prices uh decide which drugs are covered by insurance and whichies are in network. This is all while owning and operating their ownies. Express Scripts, Optimx and Care manage 80% of drug claims in this country and they're owned by Sikna, United Health and CVS which also owns Etna.
▶ 0:37:18It would be understandable to assume all these names mean different things, but health care monopolies control every part of the system. They profit off of families having to choose between rent or groceries or child care um or their life-saving medications. This administration has come out against PBMs, but they've made it abundantly clear that the issue is not uh with exploiting consumers, it's with who benefits from the exploitation.
▶ 0:37:44Over the last several months, the Trump administration has signed secret deals with 16 drug companies uh in exchange for three-year exemptions from tariffs. The White House claims these deals have secured the lowest drug prices ever. And I'm sure it's just a coincidence that Donald Trump Jr. sits on the board of Blink RX, a company that serves to profit from pharmaceutical companies establishing direct consu to consumer platforms that comply with President Trump's demands. Dr. Soal, what do we know about Trump's deal with drug companies?
▶ 0:38:13Is there any evidence these deals created the lowest drug prices
▶ 0:38:19Thank you so much for this question. I think the attention on international drug prices helps us identify that we're paying so much more than other countries. But uh how to imp incorporate that into getting a better deal for us in these negotiations in these announcements. These are voluntary deals that the industry has uh taken up together with the administration. We don't know how long they last. We don't know why. Some manufacturers have agreed and others haven't.
▶ 0:38:46And so why didn't manufacturers do it before if they can sell right at these lower prices? So uh leaving those um leaving those mechanisms to incorporate external prices into getting lower prices for us should be incorporated into things that are written in statute. For example, the Medicare drug negotiation program. in the first Trump administration, we had that idea for part B drugs and we could have it today as part of the Medicare drug negotiation program as well.
▶ 0:39:15Thank you. I'd also add that reports show uh more than half of the drugs listed in Trump RX have cheaper alternatives um on other direct to consumer sites. Consu conservatives are celebrating drug pricing transparency through PBM reform in the same breath is celebrating Trump's secret dealings with drug companies and we can't stop at transparency. We have to actually lower those costs. So your testimony mentions a gap in recent PBM reform policies where they don't actually modify the high prices that the manufacturers change. So does the law actually compel and it does does it compel lower drug prices?
▶ 0:39:45Are these reforms uh or could these reforms increase patient cost sharing or health insurance premiums?
▶ 0:39:51Thank you for this question. Um today the legislation that covers you know increased transparency increased disclosure of information between PBMs and their clients that does not change how manufacturers charge how much manufacturers charge for their drugs and that's a special problem for drugs that are in our market without competition.
▶ 0:40:10We have in today very few drugs that account for a large portion of the spending and don't have competitions generics and bioimilars and that's the kind of drug that we negotiate price in Medicare and we achieve very significant price reductions however all the six 150 plus million beneficiaries that are getting their u insurance coverage through the commercial market they don't have access to these lower costs to these lower prices and that's a huge gap because that really weighs like was said on their
▶ 0:40:40uh paychecks, on their benefits, and so on.
▶ 0:40:43Thank you. So, between PBM reforms and Trump RX, we're still aren't making a dent in the real problem. Healthcare monopolies, the president and his family profiting while people in this country go bankrupt trying to afford care. The problems we're seeing with PBMs are a natural byproduct of a failing health care system that relies on profits over human lives. It's important that we hold PBMs accountable, but that's only going to address the symptoms of an underlying failing system.
▶ 0:41:09We need universal health care so that no American ever has to rely on a GoFundMe uh for life-saving medications or so that no one is choosing between feeding their families or paying for insulin. Americans pay three to four times more for medication than in Canada, the United Kingdom, France, Japan, and Australia. So when we say that we can take steps, that's great.
▶ 0:41:33But at the end of the day, we need to pass Medicare for all so that all people in this country are covered or no longer going bankrupt and are able to access the care that they need and that they deserve. Uh thank you so much for your time and I yel back.
▶ 0:41:46Gentle lady yields. And now I call on our chairman Wahberg for his five minutes of questioning.
▶ 0:41:52Thank you, Mr. Chairman, and thanks to the panel for being here. It's good to see some of you again. we haven't seen for a little while and appreciate your involvement here today. Mr. Gelfand, um many of us have heard concerns from the constituents about the practice of PBMs and how consolidation of PBMs have taken away options uh for health plan sponsors and patients.
▶ 0:42:14Uh could you discuss whether employers have any type of flexibility when designing their prescription drug benefit programs? And secondly, what choices do employers have when working with PBMs?
▶ 0:42:28I'm sure the press release is being written as we speak, but a PBM will tell you that everything's negotiable and an employer can have any kind of plan that they want. But in practice, the flexibility is constrained since market consolidation limits meaningful competition. With the three largest PBMs controlling something like 90% of prescriptions, they know that they hold all the cards. So, if anyone could negotiate, it would be Eric's member companies because we're the biggest. We we pay the most. We have the most covered lives.
▶ 0:42:57But oftentimes, we're just stuck. Take one of the couple options that they offer or take a hike. Um, one strategy many of our member companies have tried is mixing and matching vendors. So, it's carving out the pharmacy benefit so we not using the same company for the medical plan and the pharmacy plan. But this is increasingly difficult as those companies just get bigger and bigger and more vertically integrated and they've got more clout in the entire healthcare
▶ 0:43:23So choices ultimately are kind of a
▶ 0:43:26Well, smaller employers have very few choices. They may be just stuck with the PBM chosen by their TPA. With a larger employer, you might be able to choose between a traditional PBM or a smaller upstart PBM, but that sometimes is a hard sell because they're smaller, so they may get worse prices from big pharma. Um, and once they settle on a big PBM, an employer may be able to choose, do I want a rebate plan or a spread focused plan, but these what we're talking about is how to pay the PBM, not how to design a plan that benefits patients.
▶ 0:43:56Thank you. Uh, Mrs. Deacon, according to the Federal Trade Commission, the market for PBM services is highly concentrated. uh and the largest PBMs are now also vertically integrated with the nation's largest health insurers and specialty um and retail pharmacies as a result of a high degree of consolidations and vertical integration. How much ability and incentive do PBMs have to prefer their own affiliated businesses?
▶ 0:44:30In short, they have a massive incentive. Um, in that FTC report that you actually referenced, um, I think one, uh, an excerpt from a PBM executive really said it best. Uh, quote, "You can you can get the drug emitanab methylate at a non-preferred pharmacy at Costco for $97.
▶ 0:44:51We've created plan designs to aggressively steer customers to home delivery where they can get the drug for where the drug is $200 times higher. The optics are not good. End quote. Right? The optics are not good. They recognize this because it hurts plan sponsors and patients. The economics are fantastic for the PBM.
▶ 0:45:16So as they have vertically integrated and own everything from the insurance company to the PBM to the specialty pharmacy to the rebate aggregator group purchasing organization and now even manufacturers themselves um they own the entire vertical line and absolutely have a a a motivation and financial incentive to steer as many patients to those high profit channels as possible.
▶ 0:45:41And as it relates to this bill, those high channels are often compensating the broker consultants on a per claim basis.
▶ 0:45:49So for the very popular Orisa health plans, that has a negative impact $2,900 versus um you know $97 for a drug. There is an incentive to steer that employer and their members to the $2,900 drug which the patient is paying a percentage of um and the employer is paying full freight on. Yeah, thank you. Um, Mrs.
▶ 0:46:13Anderson, um, these same brokers and consultants are responsible for advising the health plan sponsor on the selection of PBM um, and everything involved with it uh, appears in some type of conclusion. Are these brokers and consultants also responsible for advising the plan sponsor on the terms of the contract with the PBM?
▶ 0:46:37Yes, they are. and uh and they're not really doing their job to hold them responsible. So, these brokers and consultants are advising the plan sponsor on a variety of different options for the group health plan for the for the employee welfare benefit plans that the company may excuse me offer. And they're not doing their job when they're steering them to the most expensive options.
▶ 0:46:57Because again, if a patient can go and get something at a cash price for $28 or $3, but it's actually costing the group health plan $10,000, that's my money as an employee. that's going out the door. That is not my compensation package. That's not my benefit package that's being used
▶ 0:47:15Thank you. I yield back.
▶ 0:47:19Gentleman yields. Now I call on Mr. Manion from New York for his five minutes of questioning.
▶ 0:47:25Thank you, Mr. Chair. Thanks to all of our witnesses for being here today. This hearing uh will help inform our continued work in tackling rising uh health care costs. I hear from my constituents every day prescription drug costs are out of control and can be devastating a devastating burden on families. Earlier this year, I was proud to vote in favor of the PBM reforms we passed to help improve price transparency and bring cost down.
▶ 0:47:52Requiring PBMs to disclose their compensation and pass through rebates directly to the health plan was a common sense measure to ensure plan participants reap the benefit. However, the work we've done is just the start when it comes to addressing drug costs.
▶ 0:48:07The inflation reduction act gave us a model that legislation created the that legislation created the first drug price negotiation program for Medicare beneficiaries and capped annual out-ofpocket costs for Part D drugs. We should be working to extend these savings to the more than 160 million Americans who receive coverage through their employer.
▶ 0:48:32As some of my colleagues have noted, the Lowering Drug Costs for American Families Act would build on recent reforms by making Medicare fair price negotiation available to all Americans with private health coverage. It would also limit out-of-pocket drug costs under Orisa covered health plans and prevent pharmaceutical companies from raising prices faster than inflation among other reforms.
▶ 0:48:57I'm hopeful that this committee will give consideration to proposals like this and also find bipartisan agreement on future PBM reforms. Professor Soal, my question is for you. An important provision of the inflation reduction act is the requirement that pharmaceutical companies provide a rebate to Medicare when they raise the list price of drugs covered by Medicare Part B and Part D.
▶ 0:49:23However, because of procedural obligations raised uh by Senate Republicans, these rebates do not apply to drugs provided to privately insured So would you please talk about the significance of ensuring the inflation rebates also apply to commercially insured patients?
▶ 0:49:46Thank you so much for this question. First of all, it is really important to have the inflation rebate because in this country there is a tendency of these list prices just going up over time without any changes to the drug any innovations and that's what really drives the higher prices we pay as compared to other countries. Now it's not only about penalizing manufacturers is also about deterring them from raising these prices.
▶ 0:50:13So the inflation rebate is today it's calculated by the difference what is the actual price versus what the price would have been if it was according to inflation and it's multiplied by the number of claims in Medicare. Now Medicare has a lot of beneficiaries. It spends a lot on prescription drugs.
▶ 0:50:30But when we compare that to the commercial market that really covers about 50% of prescription drug costs, that's a much heavier penalty, but more importantly, a much heavier deterrent against these raising list prices. And that has a direct implication on patients that are paying over these prices over time.
▶ 0:50:50Thank you for that. And how does the Lowering Drug Costs for American Families Act address this issue to ensure that commercial plans would be included? Um when it comes to those
▶ 0:51:01I think the very first and most important thing is including these claims, right? This this that's the way that the rebate calculate it's calculated and that's what determines the weight on manufacturers's pockets, how much rebate they would have to pay. So that's really what would change if I have to pay all of a sudden a much bigger amount. Also, there are some drugs that are more relevant in the commercial space. So today if they don't have many units in Medicare, these manufacturers are fine with raising prices, right?
▶ 0:51:29So that expansion of the of the units that are accounted for in these two environments would serve as a big deterrent and some estimates would have savings as well for the commercial market. Some estimates have up to $ 31 billion by 2030 both for plans and for beneficiaries in the commercial market.
▶ 0:51:51Thank you for that. Thank you, Mr. Chair. Thank you, professor, and I yield
▶ 0:51:55Thank you. Um, I'm recognize myself for five minutes. [clears throat] Um, our healthcare system is under serious strain, not just because of complex or expensive, but because some have learned how to use that complexity for their own financial gain. This has led to a health care system that has been pulled in opposite directions where patients are told are told price costs are going up while the middlemen record profits. PBMs are not created to be the billions of the billions.
▶ 0:52:22Uh they were meant to be help the patients to negotiate lower price drug prices, improving access and bringing order to a fragmented system. But over time this purpose has drifted. Today too many PBMs seem more focused on taking value out of the system than delivering value to the patient. And this is not accident. It's the result of incentives that reward secrecy, consolidation, shifting profits into shadows instead of rewarding openness, competition, and patient care.
▶ 0:52:51At the end of the day, this hearing is about accountability. It's about transparency. It's about whether we are willing to confront a system where too often profit comes before patients. And again, I want to thank the the witnesses for being here today. This is a very very important topic that we're going through right now. Uh, Miss Anderson, um, uh, as we touched on before, the major PBM managers, PBM control approximately 75 to 80% of the total US prescription drugs.
▶ 0:53:18Uh, what would be the impact if we were to take this back to the free market as opposed to the monopoly that we're now seeing? What would be the the difference we'll see as in the entire supply chain?
▶ 0:53:28And and thank you for the question. I really appreciate it because I think this is what we're seeing with Trump RX. you know, the president put Trump RX together to to make sure that we were taking the middleman out of the system. And so for some of the drugs that we're seeing that an 86% and 90% 95% cost reduction for American patients and patients can go and buy that directly without using their, you know, PBM or other middlemen and they're seeing a really uh true cost reduction on a drug that they might want to purchase and then not go through step therapy or other utilization
▶ 0:53:59management tools to get to. So for a drug like Humumera, which is I think now listed at $425 a pen on Trump RX, that's a huge cost reduction from the list price of $6 or $7,000. And that's thanks to President Trump's leadership in putting Trump RX together so that American patients can see what it would be like to have a no middleman price on drug on prescription
▶ 0:54:22Thank you. Uh Mr. Jefffield, Jon, is that okay? Thank you. is a growing recognition that limited transparency in PBM operations makes it difficult for policy makers to fully access the costs that are occurring. Based on your work, uh what are the most critical data gaps that Congress should be focused on and close this and better understand the marketplace and how it functions?
▶ 0:54:45Thank you for the question, Mr. Owens. Um plan sponsors believe that our claims data belongs to us, that it should be in our possession. It's it's developed based on what we pay for and what our patients pay for, but oftentimes we do not get access to those claims. Congress attempted to solve this problem in 2021, passing the Consolidated Appropriations Act that that banned so-called gag clauses wherein a TPA or a PBM would refuse to provide data to the plan that generated that data.
▶ 0:55:15However, it hasn't worked. The result has been that the PBMs and TPA has simply said, "We have other reasons for not providing that data. It's proprietary. It belongs to us. Without it, we can't truly know what we're spending on what or where the money is going." I think if we could solve that problem in combination both with the reforms that were passed in February and with the regulation that should soon be coming finalized from the Department of Labor, we will have enough knowledge of the ecosystem that we can really start to make meaningful change.
▶ 0:55:45Thank you so much, Mr. Deacon. Spread pricing has been identified as a key way PBM generate profits often at the expense of both plans and pharmacies. In your experience, how wis how widespread is this practice? And you might have addressed this a little earlier. Um, and does it does it reflect a system that is fundamentally prioritizing margins over the patients access?
▶ 0:56:09Yeah, I believe that these practices are prolific. Um and absolutely there are times again when the profits and margins are placed above um you know whether it's a cost or a clinical analysis um whether that be through spread pricing formulary management and placement um different utilization management techniques.
▶ 0:56:34Uh employers and patients are certainly under the assumption and understanding um or for most of us that these decisions of of what drugs are we're given access to and the cost of the drugs are driven by clinical reasons not because it serves somebody else's bottom line or profits. Um but these you know continued uh this continued conduct it flies in the face of that.
▶ 0:57:01And again to my colleagueu's point uh the more data and access we can have uh the more we can begin to understand those and solve those problems.
▶ 0:57:09Thank you so much. Uh this this again is such an important conversation. It should be bipartisan. We need to stop this monopoly, not trade it off to another government monopoly. Let the free market work. There's no accountability, no loyalty. It's total greed and we need to that's not the American way. So I appreciate what you guys are doing. And with that, I'm going to uh uh recognize my my friend from Georgia, Miss McBth.
▶ 0:57:31Thank you, Mr. Chair, and thank you, ranking um member DS. Thank you to our witnesses that are here this morning. I have read your testimonies. Um but thank you for being here to discuss pharmacy benefit managers, otherwise known as PBMs, and the role that they play in limiting access to life-saving drugs. I don't have any formal questions for you today, but I do want to say I'm really encouraged by the bipartisan progress that Congress has made to curb PBM abuses.
▶ 0:57:58I like the language that I'm hearing, the discussion that I'm hearing, but there's still so much more work to be done to regulate PBM's control over the drugs that are or are not covered and the challenges patients must navigate to get the medication that they need. The big three PBMs CVS care uh Caremark Express Scripts and Optimum RX administer about 80% of all prescriptions in the United States.
▶ 0:58:27This market structure has given PBMs immense power to limit which prescription medications patients can have access to under their health plans. PBMs often employ a practice called step therapy or what I like to call fail first, which requires patients to first fail a medication preferred by an insurer before they are able to access the treatment that the patient and the doctors have agreed is
▶ 0:58:57best suited for them. The problem with step therapy is that real life people are not PBM policies are guided by business leaders and driven by profit incentives. Their lack of transparency leads to practices like step therapy and other health plan designs that do not always make sense for our patients and ultimately may not achieve the cost savings that PBMs are touting.
▶ 0:59:28But what happens to the patients who are forced to start PBM preferred medication that they already know doesn't work for them? What is the human cost for patients who must wait months and months at the expense of their health before they get the coverage for the treatments that they need? Like a teenager from Georgia with Crohn's disease, Georgia is where I represent who while preparing for a college entrance exam experienced a stress induced flare up.
▶ 0:59:58Even though she had her even though she and her doctor knew that uh biologic would be the best source of care and treatment for her, fail first required her to try a steroid first. While waiting to fail, her disease progressed. She lost 50 pounds in a matter of weeks. Her face swelled up, her hair fell out, and she lost complete control of her body.
▶ 1:00:24She also lost the chance to enjoy the milestone of her senior year. And instead of celebrating graduation with her friends, she spent the last day of high school isolating at home. That is the cost of sweeping mandates that far too often leave patients behind at the expense of their health and their quality of life.
▶ 1:00:48And while we all continue to grapple with the exorbitant cost of health care, we have to find the balance between the policies that keep cost down and still deliver the life-saving medications that our patients need. This session, Congressman Rick Allen and I reintroduced the Safeep Act, which would provide a clear and timely exceptions process for PBM mandated fail first policies.
▶ 1:01:17The legislation would require health plans to offer a step therapy exemption process for those who have already tried and failed a PBM preferred drug and for whom delayed treatment could cause irreversible health consequences. This is much needed for patients who are being steered to treatments that they know will not work for them.
▶ 1:01:43It means less time failing through the wrong medication, less time waiting to feel better and to heal. I am thankful to the Department of Labor's proposed rule that will help shed light on the financial incentives PBMs have to add certain medications to their list of covered drugs and push patients toward one treatment over another.
▶ 1:02:12But as we wait to see just how PBMs churn their profits and influence health plans, we can act now, right now, this very minute, to provide much neededed relief for patients who are just patiently waiting for care, waiting for their condition to get worse before they are ever given the opportunity to feel better.
▶ 1:02:38I urge my colleagues, all of them, to support this common sense legislation that will better protect patients from the influence of PBMs. And I yield. I now re recognize my friend from North Carolina, Dr. Fox.
▶ 1:02:58Thank you very much, Mr. Chairman, and I really appreciate our um witnesses for being here today. Um this is a really really important subject um that we've been dealing with for a long time and s seriously need to find a an answer to Mrs.
▶ 1:03:18Deacon you everybody's described the vert vertical integration the PBMs the fact that they control 80% of the market um or three of them do so how does the market power increase their leverage to enter into the complex and opaque relationships with brokers and and what are they likely to do as we pardon the expression put the screws on them
▶ 1:03:48and try to get more visibility into what they're doing. We know that people re who get their money this way are not going to give up easily.
▶ 1:04:02So what will they be doing to try to maintain their market Thank you for the question and you're absolutely right that this will not be something that they simply lay over um and accept um you know with respect to this bill. I think we know we know the game plan. Um we've seen it before.
▶ 1:04:26We see it in contracts today where these pig big PBMs contractually try to reclassify kickbacks to be something else. In fact, in one of the contracts that I highlighted in my written testimony, they in fact state in the contract um for purposes of the anti- kickback statute, this, you know, this kickback shall not be constituted as a kickback. Right? We know that will happen.
▶ 1:04:52So, I think we have to um when we're tightening those screws, be aware of that um uh and really account for that and how we're describing and not focus so much on the labels that these entities are labeling themselves and rebates and um whatever the thing is they're labeling. We have to look at the underlying economics. What are the economics here? What is this economic relationship? Um and then legislate or regulate um from there.
▶ 1:05:22uh you know their vast and growing um market share and vertical integration has just led them to be able to call the shots um and pay as much as they can again in this context to the broker and consultant community. Not all of them but many of them um to you know to pay to play and to be the only ones that are being able to be considered by employers and employees um as possible PBM vendors.
▶ 1:05:49It's astonishing to me that we've gotten into this position when even people on the street, so to speak, know PBMs are bad. I mean, I talked to people in my district who've read enough about this to know it. And it's amazing that some of the smartest people running the biggest companies in this country could have let us get into this position to begin with. Um, so I'm thinking we're going to all have to be on our toes. Mr.
▶ 1:06:18Gelfan, thank you for the work you've done over the years uh with the committee. Um what we know that over the years the National Institutes of Health says pharm pharmaceutical expenditures were over 800 billion in 2025. So we've all we know the FDC is now on top of some of these things.
▶ 1:06:43So, how I think you've talked about this, but say a little bit more about the PBM actions affecting the cost and availability of prescription drugs to ORISA Health Plan participants because that's of course what we're most concerned about.
▶ 1:07:00So PBMs, thank you by the way, Madam Cameron Chairman, um PBMs do play a central role in determining both the cost and accessibility of medications because the power to create and manage a drug formulary is the power to grant and deny market share to drugs. I've never seen a better example of this of when bioimilars for humira came to market. There were a dozen of them and they were way way cheaper than the branded product. But none of them got any market share.
▶ 1:07:28And this was 100% due to decisions that PBMs made about how to structure their formularies. And those decisions they made were based on rebates and GO fees. They were decisions that were not based on the best interests of patients or based on affordability. Even the largest employers have very limited leverage when it comes to trying to go against what a PBM wants to do in designing a pharmacy network or a formulary. And don't forget, we don't really know what goes on in rebate negotiations. It all happens behind closed doors.
▶ 1:07:57Thank you very much. And thank you, Mr. Chairman. I yield back.
▶ 1:08:01Gentle lady. And now, Miss Hayes, I'm going to get you in here before we have to recess for vote. So, you have you have five minutes of questioning.
▶ 1:08:08Thank you. Thank you to our witnesses for being here today. The cost of health care remains extraordinarily high. In my state of Connecticut, the average employee sponsor premium has reached almost $27,000 in 2025. Families are making impossible tradeoffs paying for health care as they continue to experience rising costs in essentials like gas, groceries, utilities, insurance, and housing.
▶ 1:08:36A major driver of those health care costs is prescription drugs. PBMs play a role in managing prescription drug programs, serving as intermediaries between insurance providers and pharmaceutical manufacturers to manage drug benefits. PBMs develop the formulary list of drugs covered by plans, negotiate prices, and reimburseies for drugs. In theory, this should give them significant leverage to lower patient costs.
▶ 1:09:04In practice, however, the market structure raises serious concerns about transparency. I supported bipartisan legislation signed into law in February that enacted sweeping PBM reforms in Medicare and employer sponsored plans. This legislation included increasing transparency and reducing the incentives for PBMs to favor high-pric.
▶ 1:09:27But additional reform is needed to address the opaque business practices of PBMs which are highly concentrated and vertically integrated. The PBM market is dominated by three large companies as we've heard many times today. CVS Health, Sigma Express Scripts, and United Health Group Optum RX that controls more than 80% of the market and own insurance plans and provider networks.
▶ 1:09:54As a result, these companies continue to hold significant influence over which drugs are covered and their prices. Mr. Gelfin, how do vertically integrated arrangements impact the ability of employers to evaluate PBM performance and fulfill their fiduciary responsibilities under Orisa?
▶ 1:10:15Thank you for the question. Vertically integrated PBMs, those that are affiliated with insurers and pharmacies, they can exert significant control over the supply chain. So they can design the drug formularies that determine which drugs will be covered. They can use taring and prior authorization and step therapy to create barriers and steer patients to one drug or to a different drug. They can set reimbursement rates for pharmacies including their ownies that they own.
▶ 1:10:40And remember all PVMs own specialtyarmacies and mail orderies if they don't also own um retailies. um they can create preferred pharmacy networks that can exclude competitors or exclude um independentarmacies. Um the mergers and acquisitions that keep getting approved, they almost always say that this vertical integration is going to create efficiency. It's going to save money. It's going to be better for patients because of that efficiency. But at this point, I'm not sure we could even find a credible expert who would agree that that's actually what's been happening.
▶ 1:11:11I instead the market consolidation has just been used against plan sponsors and against patients. Thank you, Professor Soal. In your testimony, you describe how mar market concentration means there's no real competition across PBM, similar to what we've just heard. According to your research, how does market concentration impact access and drug prices in rural areas like many parts of my district?
▶ 1:11:38Really important question and thank you so much for this question. I should say that um all the actions of the PBMs they do matter when there are choices in the marketplace when there are humira and bioimilars for example then they can choose across these drugs and often they choose for the highest cost and then what we see is patients not being able to afford that what I think it's even more concerning is the fact that if the patient couldn't afford the drug because of that choice that the PBM made
▶ 1:12:08and they went to the emergency room because they couldn't get the drug they needed. For example, in insulin, it is the plan that is going to pay for that medical visit and there is no skin in the game for the PBM in terms of accountability for that decision. Now, those decisions about which product to cover. We have identified in in self-insured employers how much money how much extra money they add to the employer spending.
▶ 1:12:35In one of the companies that we examined their formularies, it was a 15% change only associated with those choices, those of the products that were included in the formulary. And it is no surprise that every year one in every four Americans say we can't afford our drugs even though we have insurance because of those choices.
▶ 1:12:56Thank you. It's clear that we need to do more to improve the system. With that, I yield back.
▶ 1:13:02The general [clears throat] lady yields. Uh, a vote has been called in the House. Pursuant to the previous order, the chair declares the committee in recess subject to the call of the chair. We plan to reconvene promptly 10 minutes after the last votes have been called in the series.
▶ 2:14:37The committee will reconvene and continue questioning. And Dr. you're up for your five minutes of questioning.
▶ 2:14:45Uh thank you, Mr. Chairman. Um and yeah, thank you to all the witnesses for being here today. You know, Miss Deacon, you know, this kickback shall not be considered as a kickback. I guess it depends on what the word is is. Well, House Republicans have been working to lower health care costs for patients in their employer sponsored plans. All while reducing unnecessary delays in care. One of these reforms is the Safe Step Act, which is led by our subcommittee chairman, Mr. Allen.
▶ 2:15:16Every patient is unique, which is why a physician need spends time working through each patient's individual history to decide which treatment will be most effective. But insuranceances often require patients to ostens try their drug their preferred drugs first before moving on [music] to what the physician initially wanted to prescribe. The intent [snorts] here ostensibly is to prevent physicians from prescribing more expensive drugs when um when more affordable options are available.
▶ 2:15:46In practice though, the health plans often steer patients to more expensive brandame drugs even when generic or generic or other options are available. And I believe uh it was uh you uh uh uh Mr.
▶ 2:16:02Gelfand who said, "Yeah, biosimilars for um develop acquired minimal market share despite being dramatically less expensive than named brand uh um you know this the the the current system unfortunately isn't designed around controlling costs for patients.
▶ 2:16:22It too often is designed to financially benefit everyone except the patient and the employer plan to in other words to benefit middleman over the over the payer and over the patient.
▶ 2:16:37In the meantime, patients are exposed to preventable complications that require more visits to the doctor, emergency department visits, and even Now again, I understand the goal of step therapy if it's genuinely designed with the patient in mind or even even with some cost considerations injected, but that's often not the case.
▶ 2:16:59We sometimes see this when a patient has been on the same drug for years, shopped around for plans that cover the drug only to find out after he or she is swi switches plans that the go this drug will only be covered if they first fail other drugs.
▶ 2:17:14Even the the even more concerning scenario is when the doctor knows the patient will experience problems with the insurer preferred drug but has to recommend that the patient risk it anyway before he or she can access the drug they truly need. [sighs] Uh, Miss Anderson, uh, can you explain how step therapy protocols are designed and and why they sometimes steer, uh, patients to expensive name brand drugs rather than alternatives?
▶ 2:17:44Absolutely. And, you know, step therapy is something that again, it like you had mentioned in your remarks, it's something very benevolent. It's something that you say, okay, you know what, we want to make sure that we are doing cost containment. We're trying to manage costs for the health plans. We're trying to make sure everyone's premiums don't go up too much. But I think what's the challenge is
▶ 2:18:03and I would add if I could just interrupt a second and you know as a physician myself there are you know me too drugs you know there are you know several different statins there are several different ACE inhibitors and so on and um you know I know most of the the two classes I mentioned are now all generic but there was a day when there were you know let's say two or three generic statins and two and three name brand statins.
▶ 2:18:26It only makes sense that you prescribe the more coste effective drug first because often it works and that was my experience certainly as a clinician but proceed.
▶ 2:18:35But you know I mean and this is the case with many people who have rheumatoid arthritis, ulcerative colitis, Crohn's disease is the drug that they're being asked to fail first on is not the drug that they have maybe heard and and worked for them in the past. Yes. So, a patient is going to have their insurance restart at the beginning of the year and maybe they're going to have to restart for six months back on that drug that didn't work for them. And I think that is so heartbreaking for patients who they say we can control our cost best actually more so than the health plan, more so than the PBM.
▶ 2:19:06And they can control it best. And you know, thanks to to President Trump's reforms, many of the things between Trump RX and expansion of HSAs, that really gives uh patients more ability to control their health costs and their quality of care because they're the ones having to go through all the step therapies.
▶ 2:19:23Great. This probably is worth more than the 20 seconds we have, Mr. Gelfand. Um what should Congress consider doing to um to improve this situation? I think that there are aspects of of um safe of step therapy that could certainly be reformed and modernized. For instance, it should all be electronic. It should all take place. You as a patient should be able to track through an online portal exactly where you are in there. But there are some serious problems with legislation that's currently being considered.
▶ 2:19:52Thank you.
▶ 2:19:56The gentleman yields. And now I'll call on Mr. Courtney from Connecticut for his line of question.
▶ 2:20:02Great. Thank you, um, Mr. Allen. Uh, Miss Deacon, [clears throat] you've written extensively on the issue of PBM transparency both in your testimony and elsewhere, and I appreciate the attention to this complex relationship between PBMs, manufacturers, brokers, and other businesses that can contribute to rising costs of health insurance for employers and patients.
▶ 2:20:22One provision of bipartisan legislation that I introduced, the hidden fee disclosure act that was included uh in the Cobra Act uh in February uh amended Orisa to clarify the scope of who is a quote covered service provider that must disclose their direct and indirect compensation to planned fiduciaries. Before this change, there was confusion as to whether or not uh only companies that characterize themselves as brokers and consultants had to provide these disclosures.
▶ 2:20:50I and I think again you've written about this uh topic. So what is the significance of ensuring that a broad range of entities are covered service providers under the Orisa statute and how will that improve the ability of fiduciaries to to have real transparency and get a fair deal?
▶ 2:21:07Uh thank you for that question and and you're right this was a huge issue and with covered service providers like thirdparty administrators and PBMs taking the position that they weren't covered service providers for purposes of um disclosure after the CIA 2021.
▶ 2:21:24Um so now again employers can actually understand if conflicts exist um who's being paid by whom um if the biders or procurements being put in front of them are truly disinterested or given you know sort of uh the best advice in their interests.
▶ 2:21:45Um and I think again because of the vertical consolidation in the industry um where we have you know providers being owned by insurance companies being owned by pharmaceutical benefit managers being owned by you know specialtyarmacies they're all vertically integrated. Um knowing where those compensation dollars flow across all of those covered service providers is key. You squeeze one end of the balloon it pops up on the other. Right?
▶ 2:22:13So if you're not catching all of those covered service providers, you will be missing something. Um so I think that that's really important.
▶ 2:22:20Well, that is a really helpful um answer and very clear. So um again, we're really um excited about the fact that language was included and again really looking forward hopefully to do to make sure that you know the word gets out um that you know the these entities really are part of um the scope of the of the law. Um Dr. So, can you estimate the savings available to plan sponsors as a result of increased transparency for PBMs and other service providers? I mean, even roughly.
▶ 2:22:52Thank you for this question. Yes. Um, when PBMs have choices and they add more wasteful, more expensive products into the formulary, that's when they increase costs primarily. And we estimated that if we were to change that formula in practice, savings would be up to 15% net net of all rebates and discounts per member per month. I mean that's very significant for the self-insured employers that we have examined.
▶ 2:23:21And just to sort of put that in context, um how does that compare to savings available to plans and employers if we were to incorporate the inflation reduction act price inflation cap uh in private plans or to extend negotiated uh prices uh to to these u to that
▶ 2:23:38It's an excellent question primarily because what PBMs cannot do is when the drug has no competition. If we have a drug that has been in the market for a long time and there is no generic, there's no biosimilar like for example, it has generics in other places in the world but it doesn't have it here. So what can the PBM do? There's no competition there.
▶ 2:23:59And that's exactly the reason why we number one need to negotiate the price of these drugs, the top spending drugs that have been in our market without competition for a long time and expand those negotiated prices to the commercial market. Uh, OEMIC was negotiated in Medicare from $900 list price for 30 days to $274 per 30 days for a patient in a high deductible health plan that has to pay that full price until their deductible is reached.
▶ 2:24:29That's a very significant change and savings from expansion of those inflation rebates. I mean, OMIC has been in our market for a long time. It didn't start at $900. It just increased over time. So savings from expanding those uh rebates have been in the uh estimated as more than 30 billion uh in until 2031 for um commercial
▶ 2:24:53Great. Um again thank you to both of you for your really uh outstanding answers. With that I yield back.
▶ 2:24:58I thank the gentleman for yielding. Now I call on Mr. Fine from Florida for his line of questioning.
▶ 2:25:03Well thank you Mr. Chairman. The issue of PBMs is a complicated one. Um, I was the chairman of the healthc care committee in Florida for my final two years in the Florida House in which we in which we um dealt with PBM reform. And what I learned in my time, I had really no experience in healthcare prior to that. The speaker asked me to do it and think in part because he wanted something that I could sink my teeth into and learn a lot about.
▶ 2:25:28And what I learned in this is that there were no clean hands that that everyone wanted to blame someone else but but everyone had some responsibility. So I'll have some questions for about PBMs. But but I I would start by noting um I don't know I'm going to ask one of you at rand I'll ask the professor. Um um PBMs are responsible for negotiating to some degree with the drug manufacturer.
▶ 2:25:55I would note, by the way, that the United States of America has the lowest generic drug prices in the world. So, obviously, something's working when we have generic drugs. They're the lowest in the world. But when it comes to prescriptions, I mean to to non-generics, the ones that are under patent because they've invented, traditionally, we've had the highest prices in the world.
▶ 2:26:17So, professor, why is it that in this sort of PBM architecture that we have today, why are PBMs, I guess, so good at negotiating generic prices and so bad at negotiating prescription I mean um uh the you know the on patent drugs why why why the bifurcation?
▶ 2:26:36Thank you so much for that question. It's such a good question and I love mentioning that number. We always forget that generics are so much cheaper here. We're paying 85% of what other countries pay for the same generics whereas we're paying three times higher prices for
▶ 2:26:51well one of the reasons is because PBMs feed on these rebates that are confidential and they negotiate that only for the branded products. So uh that is part of the reason why branded prices keep going up is really to inflate that bubble and create some opportunities for profit for the PBM.
▶ 2:27:09So if we pass legislation in line with what President Trump is trying to do with Trump RX where we had international drug reference pricing where we said branded or I'm not branded under patent drugs whatever you want to call them patent protected drugs could not be sold in the United States for any more than they are sold in other countries a most favored nation. Would that resolve the issue with the PBMs because they wouldn't be able to keep pushing the list prices up. Would that solve it? One of the problems is that how do we know that it's cheaper?
▶ 2:27:40That's one of the problems. How do we know that it's cheaper than other countries? Because the same manufacturers can be giving confidential rebates to other countries. So that that's part of the story. Now, I do agree that we pay so much more and we should be finding ways to lower these prices. So, one of them uh is incorporating that into negotiation and incorporating that for our branded products.
▶ 2:28:01See, one of the observations that I had was that because we were so good on on off patent drugs, generic drugs versus non-generic drugs, was that part of the problem was that the drug companies were trying to make a lot of money in the United States um and then sell those drugs for a lot less overseas and to some degree the PBMs had to deal with that. How much of the issue do we think with PBMs? I'm going to ask Mr. Gelfin just randomly.
▶ 2:28:27um how much of the issue of the PBMs occurs when we allow a PBM to also own a pharmacy for example and we create this vertical integration that can create you know uh bad incentives. I think there's no question that when you have a vertically integrated healthcare company that owns the means of distribution as well as is deciding what will be distributed and to who you create opportunities for arbitrage right so it's interesting you look across the different major PBMs and the drugs that they choose to run through
▶ 2:28:57their specialtyarmacies as as opposed to running through retailies are different in fact there's less than a 50% overlap in what the different PBM say is a specialty drug. It's not a real definition. It's just what do we want to sell you versus what do we want to let other people sell you. So you you're creating this opportunity for them and they're going to seize that opportunity in this system and they're going to make profit from it.
▶ 2:29:19Yeah. I would wrap up by saying again I don't think there are clean hands here. I think there are challenges with PBMs. I think there are challenges with the people who hire PBM. I think there are challenges with the drug companies. I think it's a complicated system that has to be managed. And while I think there is ample room for reform, the number one thing we can do is create transparency because if we do that, people can then see what is going on and we can deal with the problems as they stand. So I thank all of you for being here on this issue and and Mr. Chairman, I yield
▶ 2:29:49Gentleman yields. Uh now I'll call on Mr. Scott from Virginia, our ranking member for his line of questions.
▶ 2:29:56Thank you, [clears throat] Mr. Chairman. Mr. Gelfeld, you mentioned that PBMs hired by employers to manage programs um often because of conflicts the employers are paying too much. What would happen if PBMs were required to act as fiduciaries?
▶ 2:30:14Thank you for the question, Mr. Scott. Um, we are in favor of making a legal change to clarify that PBM should be acting as fiduciaries because the decisions that PBMs make have a material effect on the plan and on the patients in that plan, on the prices that they pay, on the products that are available to them. And what would change is that the PBM would then have the exact same requirements that employers have had for 50 years. And when you boil it down, it's two primary requirements.
▶ 2:30:42Number one, to act in the best interest of the people on the plan. and number two to try to control costs for the plan. We don't think that those requirements are overly unreasonable. We've managed to comply for 50 years. It makes sense to have our vendors who are standing in our shoes comply as well.
▶ 2:30:57Thank you. And and if the um if you prohibit kickbacks, if you did not prohibit kickbacks, but just required disclosure of all fees, uh how would the employer actually know whether or not they're getting the best value and be able to compare plans if all he sees is is a spreadsheet of fees without knowing how effective the PBM is in actually reducing costs?
▶ 2:31:22I think transparency alone would leave two problems. The first problem is non-compliance. And as we mentioned, we've seen non-compliance with the 2021 CAA in which the brokers and consultants were already supposed to be telling us what fees they were getting and how they were being paid. And the PBMs declared themselves exempt from that, which is why Congress had to issue a clarification in 2026. CIA. Um, I think that the the second problem with that is that ultimately we do not have access to their data.
▶ 2:31:50We do not know where the the flows are and if they don't tell us, we can't really double check. we don't have right to audit all of their information. So, a ban would be more effective than simple transparency.
▶ 2:32:01Thank you. Miss Anderson, you mentioned the benefits of Trump RX. Are there examples of brand names with lower costs on Trump RX uh where there are actual charge where there are actual cheaper generics not on Trump RX where the patient could actually pay even less?
▶ 2:32:21Absolutely. I think many of the drugs on Trump RX offer a a lower price generic, but I think it goes back to the patient choice and what's working best for the patient. I know this committee has talked a lot about step therapy and I think when you go to drugs like again recently humir.
▶ 2:32:37I mean are there are there examples of generics not on Trump RX that the patient would not have been aware of where they could have paid even less than the bargain they would get on Trump RX? Um, in terms of No, I don't believe there's any generics on Trump RX at the
▶ 2:32:54Okay. So, so that so that if it's all brand names, they could have possibly paid even less by going off of Trump RX into a generic. Uh, with Trump RX, can you use your insurance to um pay the um pay for drugs off of Trump RX? No, but you can use your HSA and you can get on average a 30% discount off the drug using your HA,
▶ 2:33:18but you can't use your insurance.
▶ 2:33:19No, sir, but you can use your HSA as part of your insurance benefit. Professor Sak, did you want to comment on that?
▶ 2:33:29Certainly, I think that we we have to keep in mind that patients very rarely just use one drug, right? most chronic conditions that and drugs that people need to take for a long time, they are multi- u drug regimens. So for patients who do need drugs that are some of them may be in Trump, we have about 45 drugs in that list, but others aren't.
▶ 2:33:50So these individuals with insurance, they have to make an informed choice about wait, if I use this drug not under insurance, these other drugs under insurance, h how soon will I meet my deductible? What uh what is the best deal for me? And um I think it gets complex very quickly and I'm not sure that all patients even as a provider I could say as a provider I would try to do the best for my patient but I would be very puzzled about mathematically what would be the best deal for them.
▶ 2:34:19Thank you. We've said a lot about um the fact that prices paid in other countries are less than you pay in the United States. Are these the exact same drugs?
▶ 2:34:31They are. But sometimes our insurers are paying less. It's really about the highest price that affects our patients. That's what's paying more. After the rebates and discounts, sometimes our our insurers are paying the same. It's just not having these prices transparently available to our population. That's really why some insured, fully insured individuals can still not afford a drug, whereas their plans are paying less, but they have to pay based on the high list
▶ 2:34:58Thank you, Mr. Chairman.
▶ 2:35:05Okay. Uh, now we'll recognize Mr. McKenzie from Pennsylvania for uh, his five minutes of questioning.
▶ 2:35:13Well, thank you, Mr. Chairman, and thank you to ranking member Scott for bringing up the issue of PBMs being considered fiduciaries. I have bipartisan legislation to do that. I think that would be a positive step forward. Uh, for my questions, I'll start with Mr. Gelfin. PBMs receive compensation from employer sponsored health plans as well as other sources in the drug industry chain.
▶ 2:35:36What types of compensation do PBMs receive and how does this inflate costs and restrict the availability of drugs to employer plan participants?
▶ 2:35:46Thank you. I will try to answer that question quickly because there's a lot of line items there. Um, a PBM will receive compensation, for instance, from an employer who may pay a percentage of rebates, a per member per month fee, administrative fees based on other services like medical management, fees related to integrating the PBM with other vendors, arbitrageed amounts the PBM makes off of spread pricing, or fees in the form of so-called rebate credits when the employer finds ways to save money and the PBM then punishes the employer.
▶ 2:36:14But the PBM also collects a lot of money from pharma manufacturers. For instance, administrative go fees for the pleasure of negotiating with the GO. Formulary placement fees similar to rebates that help the drug get in front of the competition and better placement on the formulary. Data fees that are purportedly in exchange for analytics that the PBM and its GPO may require the pharma company to purchase. And in some cases, the PBM may require a drug company to sell their drugs at or even below cost to the PBM.
▶ 2:36:43So the PBM can then relabel that drug and sell at a markup at a higher price. I should also mention that pharmacies, a PBM might use an employer's money to pay a pharmacy and then claw back that money and keep it. Um these are just some examples of the very interesting and creative ways that they get paid.
▶ 2:37:00Understood. And so if you can please submit that to the committee for our review. Uh I think it's important to see that full list of all the different ways uh that they are being compensated. Next question for you would be what can Congress do to bring transparency to those forms of direct and indirect
▶ 2:37:19Thank you. I think a couple of things that should be considered is number one support the administration's work to require full transparency into the direct and indirect remuneration that PBMs receive. Um please support our efforts as well to ensure that that covers their GPOS, their specialty, their overseas drug branding entities and the other interesting parts of their enterprise.
▶ 2:37:40Um we hope that this committee and Congress will pass your your bill um the PBM fair act as well as u Congressman Allen's bill, the PBM kickback and prohibition act. Um both of these bills would crack down on some of the way the abuses that are taking place in the system. Um importantly, neither of these bills stops these companies from doing their job and doing the right thing for patients. Um Congress could also go above and beyond addressing these issues. Um but but we would be happy to submit for the record a number of other ideas.
▶ 2:38:08Great. Thank you. Next, I'll go to Mrs. Deacon PBMs and drug manufacturers sometimes negotiate prescription drug rebates that are expressly conditioned on limiting access to potentially lowerc cost generic options. How does this impact a health plan participants access to specific drugs and the cost of
▶ 2:38:30Uh thank you for the question. It directly reduces access oftentimes to lowerc cost drugs and it also increases both plan spending and outofpatient costs. When the PBMs and the um brand manufacturers enter into rebate agreements, they often do so expressly conditioned as you said on limiting access to lowerc cost generics including the exclusion of generics, bioimilars and other formularies in exchange again for higher rebates.
▶ 2:39:00Um, as my colleague stated, this is one of the reasons we didn't see a huge, you know, drop when Humira went off patent and biosimilars entered the market. They immediate, the PBMs immediately stepped in, um, and directed employer plans to their own biosimilar product that they were manufacturing and white labeling. So, um, absolutely.
▶ 2:39:22Again, I think another colleague highlighted a case where a member in a the Johnson and Johnson uh employee, Miss Luwendowski, um who is in a lawsuit, she could have gotten a drug for close to $20, but she ended up paying her cost share on a drug for $10,000 because that was the drug that was on the formulary and that decision was driven by rebates.
▶ 2:39:44Understood. Well, thank you. Uh I'll close out by just saying that I want to thank all of you for being here. I think PBMs is an important topic for Congress to be considering right now a space where we can make real reforms, bring down the cost of prescription drugs for all Americans and also increase potentially the access uh to these life-saving treatments that are out there and available on the market. So, uh look forward to continuing the conversation and just want to thank all of you again.
▶ 2:40:11Uh with that, Mr. Chairman, I yield
▶ 2:40:14Uh thanks gentlemen for yielding and now call on Mr. Sonier, our ranking member for his line of questioning.
▶ 2:40:20Thank you, Mr. Chairman. I'd like unanimous I'd ask for unanimous consent to submit for the record a statement from the National MS Society.
▶ 2:40:28Uh without objection.
▶ 2:40:31Thank you, Mr. Chairman. I'd like to start my comments um from the perspective of somebody who didn't have health problems until 10 years ago when I was diagnosed with stage 4 leukemia. Um, I was in a situation where I was told by my oncologist, you're lucky because 15 years ago there was nothing we could do for you. So the treatments that I got primarily came from American taxpayers investment in the National Cancer Institute, the National Institutes for Health and DARPA.
▶ 2:40:59And then private sector companies came in and distributed those products uh and made a reasonable profit. But unfortunately some of them came in and made and took advantage of our laws. And I also a survivor of I'm not supposed to be here because the ICU doctors six years ago at uh George Washington told my two sons when they had to fly across country that I was going to die. And because of Providence and their talent and four weeks on a ventilator, I am sitting here.
▶ 2:41:29So from that perspective, I am so grateful for much of the American health care system. But I am so angry at people who have Miss Deacon, Mrs. Deacon and I want to ask you about this part is too many people who basically are sociopaths. I mean my view of PBMs and much of the pharmaceutical industry is we we are too nice. We're dealing with organizations that are like the Sopranos kickbacks. Think of the language we're using here.
▶ 2:42:00We have to energize, Mr. Chairman, or realize what we're dealing with. We've been sort of nipping at the edges here, but we're dealing with a culture. And Mr. Deacon, you referred to this in your opening statement that are solely driven from return on investment, astronomical returns on investment. Um, I think of my drug was one of the five drugs in the initial negotiations in the Biden administration. It was about $400 a day when it was put on market by Johnson and Johnson.
▶ 2:42:29But in Australia, it was $40 a day. In Europe, it was $90 a day. Extended people's lives. People in America, the Wall Street Journal did stories about this. upper middle income people had to make life and death decisions because they couldn't afford the co-pay. Well, we walked in and Mr. chairman is you and I as friends and former business owners and me as a former Republican in a different time.
▶ 2:42:50We believe in the private sector and competition, but not when the competition is consolidated and there's no competition and the culture within those organizations do not have the intellectual capacity to understand how much pain they're causing to people. So, Miss Deacon, two things just if you could comment on that. And it's PBMs, but it's also pharmaceutical companies, not all of them. To Mr. Guilford's point, how do we incentivize better behavior?
▶ 2:43:19People have to have consequences when they take these approaches and they compete unfairly against people who actually have a social and moral responsibility. How do we get change this culture that is permeating this part of the healthcare Well, I'll I'll first start by saying that it would be a misconception to think that we have a competitive market. It would be a misconception to think that we have competition or that we even have a market. Right? Markets require transparency.
▶ 2:43:49They require that we not have information asymmetry. Um what we have today is again a very vertically integrated market that operates. Um and not just the PBMs, but I'm also talking about largely the provider side of this. I you know United Health Group is the largest employer of physicians in America. Most people don't know that. Um we have we do not have markets. We do not have competition.
▶ 2:44:14We have monopolistic um entities that are operating with that profit motive but with no check and balance of the market, right? With no check and balance of competition. Um and so I think that that that's probably the first and most important point.
▶ 2:44:32Um and I think once those forces come into the um into play and in addition uh again we have to have some check on the greed right um once those forces come into play I think we will have some checks um but it's got to be both the incentives and realigning the financial incentives number one number two ensuring that the disincentives to bad behavior are real and are felt by those
▶ 2:45:02entities.
▶ 2:45:02Thank you. And I want to point out a study has has shown that 25 of the fastest growing drugs in the United States are owned by firms that are owned by private equity companies. And then lastly, just as an example of that, if you remember Martin Srilli, who we had in front of the oversight committee where he took over a company and raised the price of uh a anti- parasitic drug that worked from $13.50 50 to $750 and he ended up spending seven years in federal prison. That would be a good disincentive.
▶ 2:45:33Thank you. I yel back.
▶ 2:45:36Okay, seeing no further questions, uh I will uh ask the ranking member uh for his closing remarks.
▶ 2:45:43I might have just made it, Mr. Chairman. I just think uh I look forward to working with you. Um, and I really hope that, you know, we are in a culture up here where we, um, unfortunately are sort of trained to get in our own ideological perspectives and say we're taking credit for this. You know, the other people are not. This is something for the sake of Americans lives and the culture in this country. If we could get together, Mr.
▶ 2:46:12chairman and really forcefully create disincentives for the bad behavior that all of the witnesses have talked about. Republicans and Democrats who believe in an American what I refer to as a mixed market system where competition is important, but that competition is based on a moral authority that you're going to do the right thing and get a good rate of return. So these folks are taking low risk and making high rates of return and everyone else pays for it.
▶ 2:46:42Mr. Chairman, I would be thrilled to work with you on proposals that not only do legally and politically uh and structurally that we have in front of us, but also capture the spirit of the urgency that I'm trying to express. This is really a cancer that has metasti metastasized on the American business culture and we could do something about it. I thank the ranking member.
▶ 2:47:10Uh without objection, I will enter in the record a letter from 52 associations in support of HR7895 uh my PBM kickback prohibition act and a letter from the National Association of Manufacturers on reforming ppms. And I'll do that without objection.
▶ 2:47:31Now, uh, thanks to our witnesses for testifying about the, uh, brokers and consultants who employers trust to help design their health care plans and the opaque financial rewards that PPMs are paying to some of these brokers and consultants. And it is time we we need to immediately do something about this. Uh this committee remains committed to ensuring that American families have access to high quality uh and affordable health care that works for them.
▶ 2:48:01Uh access to the prescript prescription drugs your doctor doctor recommends is a major part of our health care system. PVMs control the drugs that a group health plan will provide for its participants through a list of covered drugs. Americans work hard to pay their group health plan premiums and the co-pays and deductibles for their prescriptions. Health care costs continue to rise.
▶ 2:48:26It's time that we shed a light on hidden and deceptive practices that impact cost and accessibility for drug uh of drugs for American workers. Employers who place their trust in experts to help design their their group health plans need independent advice to allow them to design cost-effective, highquality health plans. This committee will continue our work and our and thank you for your cooperation.
▶ 2:48:52Uh to to design uh to stop these dis deceptive uh practices and expand access to more choices and better options for families and workers. Again, I would like to thank our witnesses for taking the time to testify before the subcommittee today. Without objection, there being no further further business, the committee stands adjourned.