Comer and Aderholt urge CMS to enforce new PBM reforms for patient care

House Committee on Oversight and Government Reform Chairman James Comer and House Appropriations Subcommittee Chairman Robert Aderholt called on March 19 for the Centers for Medicare & Medicaid Services (CMS) to use its authority to protect patients under recently enacted bipartisan reforms targeting Pharmacy Benefit Managers (PBMs).

The lawmakers said their ongoing investigation into PBMs has revealed anticompetitive tactics that increase prescription drug costs and threaten patient access to necessary medications. They urged CMS Administrator Mehmet C. Oz to ensure that new legislative measures are enforced so patients can receive appropriate care without unnecessary barriers from PBMs.

"The House Oversight Committee exposed how the three largest PBMs colluded to line their own pockets. These self-benefitting pricing tactics have done nothing but jeopardize patient care, undermine local pharmacies, and raise prescription drug prices. Congress took action to advance legislative solutions to support patients and provide greater transparency in the PBM industry. While these new bipartisan reforms take effect, CMS must also ensure patients are protected and can access quality care without interference from PBMs. Americans deserve affordable medications, and Congress will continue to work in a bipartisan fashion to restore competition in the pharmaceutical marketplace," said House Oversight Committee Chairman James Comer.

Aderholt added, "The recently passed FY26 Labor, Health and Human Services, Education, and Related Agencies Appropriations Act includes bipartisan reforms aimed at regulating pharmacy benefit management (PBM) operations by expanding federal oversight and increasing transparency. With this legislation, Congress directed reforms to protect pharmacists and their patients from harmful payment practices that drive up costs for community pharmacies and compromises patient care. Our shared goal must always be to protect patients who need the therapies prescribed by their physicians, not ‘managed’ by PBMs. CMS must now follow our lead and use its existing authority to ensure that patients are supported and can receive proper care without PBM interference under the guise of ‘utilization management.’ Accountability is essential when it comes to patient health.”

Comer began investigating PBMs' impact on healthcare costs in March 2023. In July 2024, he released a report detailing evidence that major PBMs have inflated drug prices while compromising patient care for financial gain. The Federal Trade Commission has since taken action against leading PBMs for anticompetitive practices following these findings.

The House Oversight Committee has held three hearings with executives from CVS Caremark, Express Scripts, and OptumRx as part of its efforts to address harmful practices within the industry.