Senator seeks answers from CVS over blocking access to low-cost prescriptions
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OKLAHOMA CITY (KFOR) – U.S. Senator James Lankford, R-OK, wants CVS to answer for its decision to push its own generic medication rather than allowing customers to also access other low-cost prescription drugs.
In May 2022, Medicare officials finalized sweeping changes to Medicare Advantage and Medicare Part D plans for seniors that would lower out-of-pocket drug costs for Medicare beneficiaries.
Lankford’s office says he has worked for years to pursue workable solutions to lower prescription drug costs and stand up to pharmacy benefit managers (PBM).
In 2023, Lankford introduced the Ensuring Access to Lower-Cost Medicines for Seniors Act which he says would ensure that patients can benefit from lower-cost products instead of being forced to pay for higher-priced drugs solely because of pricing gimmicks used by PBMs, the drug pricing middlemen.
Lankford’s office says this legislation would clearly establish pricing “tiers” to separate lower-cost generic drugs and biosimilar products from name-brand drugs so that patients pay less out of pocket for truly lower-priced drugs, therefore incentivizing prices to drop in order to get into the hands of patients.
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Now, Sen. Lankford has sent a letter to the President and CEO of CVS Health Karen Lynch and Executive Vice President of CVS Health and President of CVS Caremark David Joyner to question CVS’s move to prefer their own biosimilar instead of allowing customers to also access other low-cost biosimilars on the market.
“I am writing today regarding the announcement CVS made on January 3, 2024 in which CVS released plans for CVS Caremark to remove Humira from coverage on select controlled formularies for commercially-available health plans and instead covering lower-cost biosimilars…Instead of allowing for coverage of all of the lowest-cost biosimilar products on the market, incentivizing low costs and patient choice, CVS chose to cover the biosimilar that another CVS Health subsidiary, Cordavis, co-manufactured,” wrote Lankford.
Lankford, alongside 13 other Senators, also recently sent another letter to the Federal Trade Commission (FTC), urging them to complete their investigation into the PBM industry. The Senators also requested a status update on the investigation, which has now been open for over 18 months.
Many Pharmacy Benefit Managers (PBMs) have generally claimed that while generics and many biosimilars may have lower list prices than their branded counterparts, the net price for which PBMs are able to access these low list-price drug products is actually higher than the net price for which PBMs are able to access branded drug products because of the extraordinarily high discounts PBMs demand for these products. Because of the current opacity of the PBM industry, many prices are not publicly available and therefore these claims cannot be fully confirmed. CVS’s recent decision, however, hints that biosimilars may be able to now compete on both list and net price.
Senator James Lankford (R-OK)
View text of the letter here.
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