Fraud, PBMs, and the Cost of Looking the Other Way
Last month, the U.S. House Judiciary Committee released an interim staff report examining CVS Health’s relationships with digital pharmacy services. Led by Chairman Jim Jordan (R-Ohio), the report takes aim at a core policy concern: rising health-care costs. It frames competition and innovation as central tools for addressing those costs, a welcome emphasis in a debate often dominated by structural suspicion rather than market effects.
At the same time, the report leaves key questions unresolved. It gestures toward the responsibility of health-care firms to combat fraud and signals ambivalence about the role and value of pharmacy benefit managers (PBMs) in the marketplace, without fully engaging the tradeoffs those intermediaries present.
The timing is notable. Scrutiny of PBMs is intensifying, and the Federal Trade Commission (FTC) just announced a significant settlement with Express Scripts Inc. over insulin pricing, underscoring the broader regulatory pressure shaping the report’s backdrop.