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OptumRx and CVS tell Louisiana council PBMs deliver savings but acknowledge transparency gaps; both pledge quick data to LDI
Summary
OptumRx and CVS Caremark defended PBM roles, highlighted pass‑through and clinical programs, and pledged to provide LDI with requested reimbursement data within about a week; independent pharmacists and some legislators pushed back on vertical integration, auditability of GPO fees and dispensing fees.
Representatives of large PBMs told the Pharmacy Benefit Manager Monitoring Advisory Council on Jan. 22 that PBMs reduce net drug costs through rebates, formularies and clinical programs, but they also acknowledged areas where greater transparency and faster responses are needed.
OptumRx president Kate Carey said the company serves many clients and that "today 98% of our negotiated rebated dollars go back to our clients," and that OptumRx aims for 100% pass‑through by 2028. She described clinical tools and supply‑chain activities including Genoa pharmacies and home infusion services, and defended PBM efforts to expand access and lower costs. "PBMs are not the problem. We're part of the solution," Carey said.
CVS Caremark vice president Travis Tate said his company has contracted models called "True Cost" that guarantee net drug prices for plan sponsors, and that CVS currently passes through about 99% of rebates. Both PBMs told the council they would respond promptly to LDI's forthcoming data request: OptumRx said it would “respond within a week” and CVS made the same week‑or‑less commitment.
Points of contention: Independent pharmacists and several legislators pressed PBMs on sudden January reimbursement cuts, narrow pharmacy networks, audit access to GPO fees and the effect of vertical integration (PBMs owning pharmacies, mail‑order and infusion services). An independent pharmacist asked why a generic dispensed at a local store could be blocked by a benefit design; PBM witnesses said benefit design choices are made by plan sponsors and custom formularies exist for many clients.
Dispensing fees and delinking: Carey said OptumRx set a $5 dispensing fee for small Louisiana pharmacies; committee members and independent pharmacists disputed whether that adequately covers dispensing costs and raised examples of much higher benchmarks in other states. PBM witnesses opposed statutory delinking of rebates from list price, arguing that delinking could shift costs elsewhere and reduce competition in net prices.
Commitments and next steps: Both OptumRx and CVS pledged to work with LDI and to provide the requested reimbursement datasets quickly so the department can complete its analysis. The council closed the meeting asking LDI to return with preliminary findings in February, and PBMs to follow up on network and audit questions.
Ending: Members said they will use the LDI analysis to inform legislative options in the spring session and urged PBMs to prioritize responding to regulators and independent pharmacists facing acute cash‑flow stress.
