ICYMI: Carter presses insurers, PBMs on rising costs as CEOs face scrutiny

WASHINGTON, D.C. - Rep. Earl L. "Buddy" Carter (R-GA) led a press conference calling for insurance and pharmacy benefit manager (PBM) reform as the House Energy and Commerce and Ways and Means Committees questioned the CEOs of the nation's largest health insurers on practices driving higher costs and limiting patient access.

Rep. Carter was joined by members of these committees, Rep. Diana Harshbarger (R-TN), Rep. Rick Allen (R-GA), and Rep. Nicole Malliotakis (R-NY), in calling for greater transparency and accountability from insurance companies and reform of the PBM industry. These leaders on reform underscored the negative impact of insurer and PBM practices on patients, including increased integration, higher prescription drug prices, and reduced access to life-saving medications, all while these companies line their pockets at the expense of patients.

Rep. Carter Hosts PBM Press Conference

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"Across the country, Americans are paying more in premiums, more out-of-pocket, and more at the pharmacy counter, while, at the same time, seeing fewer choices and more restrictions on their care," said Rep. Carter. "In 2024, the seven largest insurers raked in $1.5 trillion in revenues and reported $71 billion in profits. That raises a very basic question: Is this system designed to serve patients or the companies' shareholders? It should not be controversial to say that health insurance exists to serve patients. But too often today, it feels like patients are the ones serving the system."

"Where do those rebates go? Through the PBM. When they own the pharmacy counter, they control physician referrals, and they are the biggest owner of physician groups in the country. Ten percent of physicians are ruled by these insurance companies. They answer to the insurance companies," said Rep. Harshbarger. "If you don't remember anything I say, remember this: That's not competition. That is control, and they control the health care system."

"PBM reform and bringing down health care costs for American families is a pressing issue, not only in my rural district in Georgia, but across the nation," said Rep. Allen. "Community pharmacies, which are critical to our rural communities, have consistently pushed for transparency into PBM operations and reforms to their tactics. I have heard about it time and time again in my district. All they want is a fair playing field."

"When we talk about affordability and health care, we know that it's the insurance companies and the pharmacy benefit managers that they own that are the reason why prescription drugs are so high and why health insurance premiums are so unaffordable," said Rep. Malliotakis. "They have vertically integrated the health care system in a way where they are the insurer, they are the PBM, they are the pharmacy, and they sometimes are even the doctor. They're controlling each and every step of the process."

Rep. Carter was also joined at the press conference by pharmacists, pharmacy students and pharmacy owners, including by Leroy Strickland of Clayton Pharmacy in Breman, GA, and Jim and Kimberly Richards of Corner Drugs in Chatsworth, GA. All have firsthand experience with the damage that PBMs and insurers have done to patients by restricting medication access and rising costs.

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