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Alerts and Updates

U.S. House Committee Probes PBMs' Alleged Audit Retaliation Against Independent Pharmacies

October 28, 2026

U.S. House Committee Probes PBMs' Alleged Audit Retaliation Against Independent Pharmacies

October 28, 2026

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The committee is concerned that PBM audits may be used as a tool to suppress an independent pharmacy’s advocacy of pending legislation.

On October 23, 2026, the U.S. House Committee on Oversight and Government Reform announced an investigation into whether the three largest pharmacy benefit managers (PBMs)—CVS Caremark, Express Scripts and Optum Rx—targeted independent pharmacies with punitive audits in retaliation for their public support of legislation HR 6610, the Pharmacists Fight Back in Federal Employee Health Benefit Plans Act.

Key Takeaways

  • The committee asked the PBMs for documents and communications about their audit practices, how they select pharmacies for audits and their nationwide audit totals for the time period of July 22, 2026, to present. This request includes all audit types.
  • The inquiry follows reports that independent pharmacies that supported HR 6610 received an unusual number of burdensome audit notices after the committee's July 2026 markup of the bill.
  • The committee asked the PBMs for a list of all audits of independent pharmacies in Kentucky, Mississippi and Florida. These three states are identified because many of the pharmacy groups that supported federal employee health benefit (FEHB) program plans are located in these three states.
  • The committee asked the PBMs to provide the total number of audits of independent pharmacies in each state or territory, including a breakdown showing the audits by the PBM-affiliated organization and nonaffiliated organization.

Background: HR 6610

Under HR 6610, PBMs for FEHB program plans would pay in-network pharmacies a benchmark price with a capped margin, plus a dispensing fee in line with what the state Medicaid program pays. The committee marked up the bill in July 2026.

The Pharmaceutical Care Management Association (PCMA), an industry group that represents PBMs, pushed back against the bill during the markup process. In a July 22, 2026, statement, the PCMA said the legislation mandates minimum reimbursement rates for pharmacies in the FEHB program would add significant cost to the program.

Audits As a Tool for Advocacy Suppression

Soon after the committee marked up HR 6610 in July 2026, multiple independent pharmacies in support of the resolution reported that they received audit notices and that some notices set a compliance deadline which was before the pharmacies even received the audit notice.

The committee is concerned that PBM audits may be used as a tool to suppress an independent pharmacy’s advocacy of pending legislation. This concern is significant because independent pharmacies often work closely with patients, especially in rural areas or regarding specialized pharmaceutical needs.

The Committee’s Investigation

In letters to CVS Caremark, Express Scripts and Optum Rx, the committee stated that independent pharmacies saw an unusual surge in burdensome audits after publicly supporting HR 6610. In the letters, Chairman James Comer wrote:

The Committee is concerned that independent pharmacies have potentially been targeted for punitive audits in retaliation for their public support of legislation recently passed by the Committee. In the short span of time since the Committee’s July markup of H.R. 6610, the Pharmacists Fight Back in FEHB Plans Act, multiple independent pharmacies that supported the Committee’s efforts have received an unusual number of burdensome audit notices in short succession from several PBMs. This raises concern that these audit notices were sent or timed to retaliate for their support of H.R. 6610.

According to the committee, one audit involved a medication that cost 99 cents and took the independent pharmacy's staff hundreds of hours to handle.

The committee asked the three PBMs for documents and communications about their audit practices, how they select pharmacies for audits and their nationwide audit totals for the time period of July 22, 2026, to present. This request includes all audit types, including desk audits, in-person audits, unannounced audits and compliance audits. The committee asked the PBMs to provide staff-level briefing promptly and no later than October 30, 2026. The PBMs’ written responses are due by November 6, 2026.

The committee asked the three PBMs for a list of all audits of independent pharmacies in Kentucky, Mississippi and Florida, including the reason for the audit and its results.

According to the committee, HR 6610 has been supported by over 60 state and national pharmacy groups, many of which are located in Kentucky, Mississippi and Florida. For example, the resolution was supported by entities from Chairman Comer’s home state of Kentucky, including Kentucky Independent Pharmacist Alliance, Kentucky Pharmacists Association, the American Pharmacy Cooperative, Community Oncology Alliance and Transparency Rising.

The committee also noted that in June 2026, the Florida Attorney General’s Office responded to concerns of efforts by CVS Caremark to impose undue burdens through the audit process.

Chairman Comer said PBMs “must not be allowed to weaponize the audit process to punish pharmacies that support greater transparency, lower prescription drug costs, and stronger protections for patients,” and that the committee “will follow the facts and determine whether these audits were legitimate or were used to intimidate independent pharmacists.”

The investigation builds on Chairman Comer's review of PBM practices, which began in 2021. According to the committee, an earlier House Oversight Committee report found that the three largest PBMs have used deliberate, anticompetitive pricing tactics that raise prescription drug prices and undermine community pharmacies. The report called on Congress to pass reforms to make the PBM market more transparent.

Previously, in August 2024, the committee issued letters to executives of three of the nation’s largest PBMs, accusing them of providing false testimony before Congress and giving the PBMs one month to correct the Congressional Record.

What This Means for Pharmacies

The investigation shows that Congress is paying closer attention to PBM audit practices and whether they are being used against pharmacies that speak out publicly. The inquiry is at an early stage, and the committee has made no findings.

For More Information

If you have any questions about this Alert, please contact Jonathan L. Swichar, Sheila Raftery Wiggins, Bradley A. Wasser, any of the attorneys in our Pharmacy Litigation Group or the attorney in the firm with whom you are regularly in contact.

Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.