U.S. Oversight Committee Probes Audits of Independent Pharmacies After They Backed Reform Bill
Key Facts
U.S. House Oversight Committee Chairman James Comer announced on October 23, 2026, an investigation into whether independent pharmacies were targeted with punitive audits because they publicly supported a bill to reform pharmacy benefit managers. The committee said it wants to determine whether benefit managers used audits to retaliate against pharmacies that backed the bill. The committee’s requests target CVS Caremark, Express Scripts and Optum Rx, the three companies that manage pharmacy benefits for CVS, Cigna and UnitedHealth. The requests cover documents, correspondence and staff briefings on audit practices, how pharmacies are selected and the number of audits. The question of retaliation remains under investigation; the committee has not announced a finding substantiating these allegations.
The committee says its concerns arose after an unusual increase in audit notices following a July hearing on H.R. 6610, known as the “Pharmacists Fight Back Against PBMs in Federal Employee Benefit Plans Act.” The bill aims to limit benefit managers’ costs within federal employee benefit plans and was introduced in the House on December 11, 2025. The committee says the sequence of audit notices after the bill hearing warrants scrutiny of their timing and the criteria for selecting pharmacies, including the possibility that selection was influenced by their public positions. The committee requested the number of audits involving pharmacies in different states and any audits involving supporters of the bill. The new investigation thus centers on the possibility that audits were used to pressure pharmacies, rather than resolving broader allegations about drug prices or company profits.
The committee’s letters to the companies cited examples it said warranted clarification from the firms. In its letter to CVS Caremark, it pointed to an audit involving a drug that cost $0.99 and said completing it consumed hundreds of hours of work at an independent pharmacy. In a letter to Optum Rx, the committee said some pharmacies underwent their first audit and then received two additional audits within a short period. Its letter to Express Scripts addressed notices that, according to the committee, included compliance deadlines that preceded the notices’ arrival at the pharmacy. The committee is asking the companies to explain their pharmacy selection procedures and the scope of the audits so it can examine the cases cited in its letters.
The investigation is part of broader oversight that the Oversight Committee began on March 1, 2023, to examine the role of pharmacy benefit managers in health care costs. The committee issued a report on industry practices in July 2024 and said it had obtained more than 140,000 pages of documents and correspondence by that month. By March 2026, the committee had held three hearings on benefit managers, including one with the chief executives of the three companies. That month, the committee said Congress had enacted bipartisan reforms to strengthen federal oversight and transparency, and urged the Centers for Medicare & Medicaid Services to use its authority to protect patients’ access to care. This context places the new document requests within ongoing oversight of the industry, while the current investigation focuses on the possibility that independent pharmacies were targeted with audits.
The importance of pharmacy selection in audits stands out against a highly concentrated prescription benefit management market. The Federal Trade Commission said in an interim report issued in July 2024 that the three largest managers handled nearly 80% of the roughly 6.6 billion prescriptions dispensed in the United States in 2023. In a later report issued in January 2025, the commission said pharmacies affiliated with the three companies generated more than $7.3 billion in drug-dispensing revenue above estimated acquisition costs during 2017–2022. It also reported that these pharmacies’ share of specialty drug dispensing revenue rose from 54% in 2016 to 68% in 2023. The commission said affiliated pharmacies’ revenue above estimated acquisition costs grew at a compound annual rate of 42% between 2017 and 2021, figures that help explain the expanded scrutiny of the market’s structure and practices.
The committee set October 30, 2026, as the deadline for the staff briefing it requested from CVS Caremark, to discuss the scope of audits, how pharmacies are selected and whether audits affected supporters of the bill. It also requested records covering July 22, 2026, through the date of the request, and set November 6, 2026, as the deadline for submitting the requested information. These deadlines will allow the committee to gather the companies’ responses and compare them with the timeline of notices and the cases cited in the letters. The committee’s letter to CVS Caremark said: “Provide a staff-level briefing no later than October 30, 2026.” The document request to Express Scripts covers records and correspondence for the specified period through the date of the request.