In late July, the House Oversight Committee held a hearing with three Pharmacy Benefit Manager (PBM) CEOs on their role in increasing healthcare costs. In that hearing, lawmakers attacked PBMs for using tactics such as claw-back fees and favoring PBM-owned facilities, thus driving local pharmacies out of business. The Committee largely blamed PBMs for the high prices Americans pay for drugs.

On Wednesday, House Oversight and Accountability Committee Chairman James Comer (R-KY-1) sent letters to the three PBM CEOs who testified, accusing them of making false statements during the hearing. In the separate letters to the CEOs of CVS Caremark, UnitedHealth’s OptumRx, and Cigna’s Express Scripts, the Chairman claimed that their testimony—that PBMs do not direct patients to their own pharmacies or pay those pharmacies better rates—was false, based on recent reports/investigations by the House Oversight and Accountability Committee and the Federal Trade Commission (FTC). Each letter details specific exchanges from the hearing where each CEO allegedly provided false testimony about PBM’s business practices.

Comer has given the three CEOs until September 11^th to “correct the record” on their testimonies.

Despite the House passing PBM transparency legislation last year, Senate action on similar reforms remains stalled. There have been discussions about including PBM reform legislation in an end-of-year healthcare package again this year. Capitol Associates will be closely monitoring any progress in these discussions as Congress returns from recess on September 9^th.

The federal government has relaunched its free COVID-19 at-home test delivery service.

Eli Lilly has announced discounted prices for single-use vials of their GLP-1 obesity drug, Zepbound, when purchased through their online pharmacy, LillyDirect. This pricing is aimed at self-pay patients and is lower than the cost at standard pharmacies. This initiative is part of a broader strategy to combat counterfeit versions of the drug.

A KFF article reveals that a decade ago, federal officials drafted a rule to address Medicare Advantage insurers’ overcharging but abandoned it due to industry backlash. The regulation sought to make insurers refund overpayments by correcting record errors but was dropped after strong pushback. This decision is now part of a major fraud case against UnitedHealth Group, accused of defrauding Medicare of billions through dubious billing practices.

The FDA’s Center for Drug Evaluation and Research (CDER) is consolidating its AI activities under a new AI Council to enhance the safety and security of machine learning software. This council will replace existing AI steering committees and policy groups while maintaining collaboration within the federal AI Community of Practice.