PBM Accountability Project Statement on House Ways & Means Committee Hearing on Medicare Fraud

The House Committee on Ways & Means will hold a hearing on April 21 titled “Protecting Patients & Taxpayers: Cracking down on Medicare Fraud.” Mark Blum, managing director of the PBM Accountability Project, issued the following statement: 

“The PBM Accountability Project welcomes the House Ways & Means Committee’s focus on identifying and addressing fraud in the Medicare program. As lawmakers examine vulnerabilities that drive unnecessary costs for taxpayers and beneficiaries, it is essential to include the role of vertically integrated insurance corporations and their affiliated pharmacy benefit managers (PBMs). 

“Recent congressional action and administrative rulemaking to advance PBM middlemen reform mark important first steps toward improving transparency and accountability in the prescription drug supply chain. Significant concerns remain, however, regarding the degree to which certain vertically integrated health insurers and their affiliated PBMs may contribute to higher costs in Medicare. Ongoing enforcement actions by state attorneys general and findings from federal audits have raised questions about billing practices, financial arrangements and the flow of prescription drug dollars within federally funded programs. 

“As the Committee undertakes its oversight work, we urge lawmakers to examine how gaps in transparency and oversight may allow vertically integrated insurance and PBM practices to increase costs for Medicare and its beneficiaries. Strengthening reporting requirements, enhancing audit authority and ensuring that financial incentives are aligned with patient affordability would help promote greater accountability across the system. 

“A thorough review of these issues will help ensure that Medicare resources are used efficiently and that savings are passed on to seniors and taxpayers.The PBM Accountability Project looks forward to working with the Committee to support policies that reinforce the integrity of the Medicare program, improve transparency and protect patients.”