This week, Rep. Keith Ellison (D-Minn.) wrote a letter to Department of Health and Human Services’ Secretary Alex Azar requesting an explanation of the decision to hire CVS Caremark Vice President Daniel Best to lead the agency’s drug pricing reform effort. 

“Given Mr. Best’s career working for the pharmaceutical and pharmacy industry, the decision to hire him poses significant potential for conflicts of interest, placing him in position to make decisions that may pit the income of his former employers against the interests of seniors in reducing prescription drug prices,” Ellison wrote. "These ties raise questions about his ability to create fair and consumer-friendly policies to rein in rising drug costs.”

Ellison pointed out that last year, on average, Pfizer raised the cost of 91 drugs by 20 percent. Since 2012, Pfizer raised the cost of some of its older drugs every six months.

“During the time Best worried for Pfizer, the company aggressively fought to keep patients on its more expensive brand of cholesterol medication while a less-expensive generic equivalent was available,” he wrote. “Mr. Best’s tenure at Pfizer raises serious questions about his ability to create fair and consumer-friendly policies at HHS and his ability to rein in rising drug costs.”

“While Pharmacy Benefit Managers like CVS Caremark serve to negotiate savings for consumers, they are a for-profit industry with a record of making a profit off fees paid by insurers and employers, and keeping a cut of the rebates they negotiate,” he added. “The lack of transparency associated with their business model, as well as the high level of market concentration in the industry, casts doubt on the efficacy of their role in cost control. In fact, there is evidence to suggest CVS Caremark crossed legal and ethical lines during Mr. Best’s time at CVS Caremark.”

In February 2018, HIV patients filed suit with CVS Caremark, alleging the benefit plan abruptly stopped covering their prescription costs at certain pharmacies, pushing them back to CVS locations. “These allegations, if true, would reveal disturbing, unethical behavior on the part of CVS Caremark that undermines basic consumer protections,” Ellison wrote.

He requested a response by April 26 to a series of questions, including, “What measures will Mr. Best take to ensure his conflicts of interest do not affect his charge to help lower prescription drug prices?” and “Will Mr. Best recuse himself from all decisions that affect Pfizer or CVS Caremark?”

Other questions included:

Which outside organizations or individuals were consulted prior to Best’s hiring?

During his time in the private sector, or at any time, has Best ever lobbied HHS or the U.S. Congress or advocated for any policies related to prescription drug pricing?

What measures will Best take to ensure his conflicts of interest do not affect his charge to help lower prescription drug prices?

Will Best recuse himself from all decisions that affect Pfizer or CVS Caremark?

Has Best divested from all CVS Caremark, Pfizer, and all other pharmaceutical and pharmacy-related investments or interests?

Will Best receive a pension from CVS Caremark or Pfizer?

The letter also points out that the Centers for Medicare & Medicaid Services recently issued a proposal for comment which would return a portion of drug rebates directly to consumers. This proposal will directly affect CVS Caremark and Pfizer, both of Best’s former employers. Ellison asked: “Will he recuse himself from work on this proposed rule? If not, how will he ensure impartiality to ensure this proposal—should it move forward— provides the greatest direct benefit to consumers rather than his former employers?”

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