U.S. Rep. Buddy Carter (R-GA) on Jan. 22 called for insurance and pharmacy benefit manager (PBM) reform and joined House Republicans in questioning the CEOs of the nation’s largest health insurers on practices driving higher costs and limiting patient access.
“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,” Rep. Carter said during a press conference.
In 2024, he said, 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?” asked the congressman. “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.”
CEOs of the nation’s largest health insurers and PBMs appeared before both the U.S. House Ways and Means Committee and the U.S. House Energy and Commerce Health Subcommittee, on which Rep. Carter serves.
They discussed why premiums, deductibles, and out-of-pocket costs continue to rise for American families as part of the first in a series of hearings on healthcare affordability amidst health spending at record levels and consolidation in the insurance, pharmacy, and care delivery markets limiting choice and competition.
Republicans on the committees challenged industry leaders to account for a system in which they said prices, coverage decisions, drug access, and provider networks are increasingly controlled by a handful of corporate entities.
During his subcommittee’s hearing, Rep. Carter was joined by several GOP members in calling for greater transparency and accountability from insurance companies and reform of the PBM industry.
They 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, according to a summary provided by Rep. Carter’s staff.
Rep. Carter was also joined at the press conference by pharmacists, pharmacy students, and pharmacy owners, who provided firsthand experience regarding what they consider is the damage done by PBMs and insurers to patients by restricting medication access and rising costs.