House Oversight Committee Investigates Cigna and Optum Rx's Foreign GPO Ties for Potential Evasion of U.S. Transparency Laws

The House Committee on Oversight and Government Reform is digging deeper into the intricacies of pharmacy middlemen politics, broadening an inquiry into Pharmacy Benefit Managers (PBMs) and their ties to foreign-based group purchasing organizations (GPOs). Chairman James Comer (R-Ky.) has pressed The Cigna Group and Optum Rx for records, in an effort to shine a light on potential transparency and oversight loopholes leveraged through international GPO operations.

In a move to untangle the web of pharma's behind-the-scenes financial maneuvers, Chairman Comer has directed his attention overseas, addressing Cigna Group's use of Ascent Health Services, Inc., based out of Switzerland, and Optum Rx's Ireland-headquartered Emisar Pharma Services, LLC. “The Committee is investigating whether Cigna Group’s Evernorth Health Services, the parent company of Express Scripts, uses its foreign headquartered group purchasing organization (GPO)—Ascent Health Services, Inc. (Ascent) which is headquartered in Switzerland—to evade transparency and oversight in the United States. The Committee requests documents and communications regarding the creation and role of Ascent,” Comer outlined in his correspondence with The Cigna Group, as noted by the Oversight Committee press release.

This inquiry dovetails with a report published by the House Oversight Committee last July, which dissected the role PBMs play in the prescription drug markets. The document pinpointed PBMs' anticompetitive practices and their role as profit-protecting intermediaries. Adding to this, the investigation illuminates the added obscurity brought about by GPOs, especially those operating from outside U.S. borders—entities that might bypass legislative and regulatory reforms within the States while pocketing additional revenue.

Citing concerns over transparency, Comer's requests to the healthcare giants are straightforward: hand over documentation and communications related to the establishment and operation of these overseas GPOs. “The Committee is investigating whether UnitedHealth Group’s Optum Rx, uses its foreign headquartered group purchasing organization (GPO)—Emisar Pharma Services, LLC (Emisar Pharma) headquartered in Ireland—to evade transparency and oversight in the United States. The Committee requests documents and communications regarding the creation and role of Emisar Pharma,” Comer stated to Optum Rx. Though GPOs have long been defended as tools for cost savings and efficiency boosts within an increasingly complex pharmaceutical industry, the layers of structure and, international elements introduced may indeed contribute to market opacity, according to the same press release.

The investigation continues.