Rep. Lee Holds PBM CEOs to Account for Ripping off Western PA Patients in Oversight Committee Hearing

**For Immediate Release**

Vaibhav Vijay, Vaibhav.Vijay@mail.house.gov 

Kyla Gill, Kyla.Gill@mail.house.gov 

Rep. Lee Holds PBM CEOs to Account for Ripping off Western PA Patients in Oversight Committee Hearing

Washington, DC – July 22, 2024 – Today in the House Oversight Committee, Congresswoman Summer Lee criticized the monopoly power perpetuated by hospitals and health insurance systems–and tied it directly to the higher costs, reduced access, and worsened health outcomes for patients in Western Pennsylvania and across the country. She also pressed the heads of CVS Caremark, Express Scripts, and OptumRx on their excess profits–all made as a middle-man between patients and the care that they need.

Watch the full remarks here:

Full Line of Questioning:

In Southwestern Pennsylvania, we’re all deeply familiar with the consequences of concentrated corporate power in our healthcare systems. Whether it’s a hospital system, a health insurance conglomerate, or both combined, the consequences of a healthcare monopoly are always the same: higher costs, reduced access, and worsened health outcomes.

And with health insurance companies like UnitedHealth, Cigna, and Aetna, it’s evident that—through their monopoly power—they’ve been able to rig our healthcare system to prioritize profits over patient health, capitalizing on each level of the drug supply chain to boost shareholder returns.

Last year, the parent companies for all three PBMs testifying here today were incredibly successful, as evidenced by their windfall profits. 

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Question 1: 

David Joyner

Mr. Joyner, how much total revenue did CVS Health report in 2023?

Q:  And how much of that total amount was attributable to Caremark? 

A: Just shy of $180 billion, I believe, 

Q: And how much of that total was attributable to Caremark?

A: So the Caremark revenues, were just shy of 180 billion

Adam Kautzner, PharmD (Express Scripts)

Q:  Mr. Kautzner, how much total revenue did Evernorth Health Services report in 2023? 

A: Congresswoman, I don’t know the exact amount, but it’s certainly within the the filings that we provide what I can say is, I believe it’s 153 point 5 billion

Q:  And how much of that total amount was attributable to Express Scripts?

A: So we don’t report the Express Scripts segment on its own, so I couldn’t provide that information.

Patrick Conway, MD

Q:  Dr. Conway, how much total revenue did UnitedHealth Group report in 2023?

A: I believe it was in the high three 60 billion in terms of revenue for the whole group. 

So while your three companies earn billions, Americans continue to pay some of the highest costs for medications in the world.

Last March, the Kaiser Family Foundation released data showing more than a quarter of adults said it was either somewhat or very difficult to afford prescription drugs. For people of color, 60% of Black respondents and 65% of Hispanic respondents reported

difficulty affording health care.

And this is despite your claims of negotiating significant rebates from drug manufacturers to lower drug prices.

To each of you: 

It appears that this system of rebates actually benefits the PBMs rather than the patients. How do you explain this discrepancy?

Mr. Conway, last year Optum Rx’s former CEO testified before the Senate Committee on Health, Labor, Education, and Pensions.  She explained that some of your customers, quote, “choose to compensate us for the savings we generate and the services we provide by opting for us to retain a small fraction of the discounts we negotiate with pharmaceutical manufacturers.”

Patrick Conway, MD

Q: Dr. Conway, for companies that choose this compensation model, what percentage of the discount you negotiate with drug companies does OptumRx retain on average?

A: The majority of customers choose 100% rebate pass through on average across the entire book, it’s 98% of rebates that are passed through to our customers.

Your former CEO also stated that, quote, “Other customers prefer that we pass along 100% of the savings we negotiate and instead compensate us via administrative fee.”

Q:   Dr. Conway, on average, how much do clients who choose this model pay OptumRx as an “administrative fee”?

A: They have a set of choices and how they pay us. Some of the some of them choose administrative fees. There’s a set of options that we provide to them transparently that they select and how they reimburse us for our services.

It’s clear that the savings you claim to be providing to patients are either woefully inadequate or not reaching them at all. I look forward to working with my colleagues to rein in PBM monopoly power and lower drug costs for all patients.

Thank you, I yield my time.

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Since taking office in January 2023, Lee, who serves on the House Oversight Committee and Space, Science and Technology Committee, has delivered historic levels of federal investment totaling over $1.85 Billion brought back to Western PA, including over $580 million for infrastructure, over $110 million for affordable transit, over $500 million to keep clean energy manufacturing at home in Pennsylvania, and over $55 million on clean energy efforts in and around schools to help keep our kids and communities safe. These investments will help improve Western Pennsylvania’s infrastructure and transit, ensure cleaner air and drinking water, lower housing costs, fund research institutions, fuel clean manufacturing, fund STEM innovation and entrepreneurship, boost workforce development, and create thousands of good paying union jobs.  Lee and her team have also delivered casework and constituent services to over 2,300 constituents with issues ranging from helping our seniors and disabled community access Medicare and social security to helping folks secure housing and helping families with immigration support and passports.