EL7.AI
GeneralMedium•26 October 2026•
4 min read

US probe examines alleged punitive audits of independent pharmacies that backed reform bill

Key Facts

1James Comer announced the investigation on October 23, 2026, into allegations that independent pharmacies were targeted with audits after supporting federal legislation.
2A committee statement cited an audit involving a drug that cost 0.99 dollars and required hundreds of hours of work.
3H.R. 6610 provides for an additional reimbursement of the lesser of 4% of the National Average Drug Acquisition Cost or 50 dollars.
4The three largest benefit managers handled nearly 80% of roughly 6.6 billion prescriptions in the United States in 2023.
5The Federal Trade Commission estimated more than 7.3 billion dollars in dispensing revenue at pharmacies affiliated with the three largest during 2017–2022.

James Comer, chairman of the US House Oversight and Government Reform Committee, opened an investigation on October 23, 2026, into whether independent pharmacies were targeted with punitive audits after publicly supporting legislation to reform pharmacy benefit managers. The committee said several pharmacies backed its efforts and then received an unusually repeated run of audit notices from multiple companies. The investigation examines whether the notices were connected to the pharmacies’ positions on the legislation, a question the committee has not resolved. The committee is investigating whether the audits were legitimate or amounted to intimidation, and has announced no finding establishing either possibility. The practices and selection of pharmacies are now under congressional review, while the evidence contains no position from the companies involved.

The committee asked CVS Caremark, Express Scripts and Optum Rx to provide documents, correspondence and staff-level briefings on audit procedures and pharmacy selection criteria, as well as nationwide totals for audits conducted. The request allows the committee to examine how pharmacies are selected for review and compare individual cases with the overall volume of audits. It also sought detailed records of audits involving independent pharmacies in Kentucky, Mississippi and Florida. The committee links those records to its investigation into the sequence of notices received by pharmacies that supported the legislation. The evidence did not give a deadline for submitting the documents or a timeline for completing the investigation.

Comer said several independent pharmacies received an unusually high number of burdensome audit notices, closely spaced in time and from more than one pharmacy benefit manager, in a short period after the committee considered H.R. 6610 in July. A committee statement cited an example of an audit involving a drug that cost 0.99 dollars but required hundreds of hours of work by staff at the independent pharmacy. The example highlights the administrative burden the committee says may accompany these audits, regardless of the value of the drug under review. The connection between the notices and support for the bill remains among the allegations the committee is examining. The investigation has not established that the audits were retaliatory or that the companies’ procedures violated rules.

The investigation concerns H.R. 6610, known as the Pharmacists Fight Back Act in Federal Employees Health Benefits Program plans, which was introduced in the House on December 11, 2025. The bill was referred to the House Oversight and Government Reform Committee, so it was still under consideration when the investigation was announced. Its provisions target pharmacy reimbursement rules in the Federal Employees Health Benefits Program, making pharmacies’ positions on the bill central to the allegations the committee is examining. The bill provides for a pharmacy’s in-network drug cost reimbursement to be based on the National Average Drug Acquisition Cost, plus the lesser of 4% of that amount or 50 dollars. It also ties the professional dispensing fee to what the state pays under Medicaid.

The committee had set July 22, 2026, for a hearing on the bill. It said the provisions include pharmacy reimbursement, directing manufacturer rebates to reduce beneficiaries’ drug costs, barring patients from being steered to a benefit manager’s affiliated pharmacies, and imposing penalties for violations. These provisions reflect the scope of the proposed changes to the relationship between benefit managers, pharmacies and beneficiaries in the federal program. The audit investigation followed the bill hearing, according to the sequence of events Comer described. The committee says reviewing audit and selection documents will help it determine whether the repeated notices were justified practice or a way to pressure pharmacies that backed reform.

The case comes in a sector where prescription management is concentrated among a small number of companies. In a 2024 report, the Federal Trade Commission said the three largest pharmacy benefit managers handled nearly 80% of the roughly 6.6 billion prescriptions dispensed in the United States in 2023, while the six largest handled more than 90%. Those shares provide context for the scale of the role played by the three companies from which the House committee requested documents in the current investigation. In an interim report issued in January 2025, the FTC estimated that pharmacies affiliated with the three largest benefit managers generated more than 7.3 billion dollars in revenue from dispensing specialty generic drugs above estimated acquisition cost during 2017–2022. The 10 largest drugs in the analysis accounted for 6.2 billion dollars of that total, the commission said, as part of a wider debate over the role of benefit managers and their affiliated pharmacies in the drug market.