By Sarah Karlin-Smith and Sarah Owermohle with POLITICOPRO
Five pharmaceutical benefit managers (PBM) have agreed to testify about drug pricing at an April 9 Senate Finance Committee hearing that will focus on the PBM industry.
The five invitees — Humana, CVS, Cigna, OptumRx and Prime Therapeutics — each confirmed their attendance to POLITICO. Committee Chairman Chuck Grassley’s (R-Iowa) office said Tuesday that four of the five invited companies voluntarily agreed to have their chief executives testify but would not identify the participants.
William Fleming, president of Humana’s health care services, will testify for the insurer. Flemming oversees its clinical and pharmacy business.
Prime’s interim CEO, Mike Kolar, will attend for the comparatively smaller PBM, which contracts primarily with state Blue Cross and Blue Shield plans. A spokesperson said the company looks forward to sharing how it adds value and works on drug pricing.
Derica Rice, president of CVS’ PBM unit Caremark, will also testify. The PBM has been in the spotlight for its Aetna megamerger along with underwhelming earnings in the midst of a possible overhaul of the drug rebate system. In December, it launched a “guaranteed net cost” contract that would let plans receive 100 percent of negotiated rebates and pay a fixed net cost estimate for each medicine. Cigna also recently merged with Express Scripts, forming another large insurer-PBM combination.
John Prince, OptumRx CEO, will be on the witness stand for the company, which is part of UnitedHealthcare. Optum has been out front in the criticism over rebates, announcing this month it will require all new employer health plans to provide point-of-sale drug discounts to patients starting in 2020. This follows its move last year to to apply point-of-sale discounts to patients in fully insured group health benefit plans starting in 2020.