EXCLUSIVE — House Republicans are probing allegedly anticompetitive practices in the vision insurance market that drive up costs for consumers, signaling a new healthcare reform priority for the 2025 legislative session.
“Consolidation in the vision insurance market raises concerns about the potential for increased costs to patients and fewer choices,” House Oversight Committee Chairman James Comer (R-KY) wrote to Attorney General Merrick Garland on Monday.
The two primary vision benefits manager companies, Vision Service Plan and EyeMed, are the leading insurance discount programs that promote the sale of eyewear affiliated with particular brands.
VSP and EyeMed combined share control of about 85% of the market share of stand-alone vision insurance plans. Within that market share, both companies use higher reimbursement rates to incentivize optometrists and ophthalmologists to sell their patients particular products.
“Vision benefit managers (VBMs) own, operate or affiliate with eyeglass and lens manufacturers, laboratories, and retail locations that employ eye care providers,” Comer wrote to Garland. “Through these ownership and affiliation agreements VBMs have fully integrated the vertical supply chain of vision care.”
Comer highlighted in the letter that Vision Service Plan is looking to expand its control over the market, purchasing 250 brick-and-mortar Eyemart Express locations across 42 states to sell its product directly to consumers.
VSP already covers approximately 70% of the vision insurance market, nearly 32 million people. That includes 1.4 million federal employees under federal employee health benefits.
Comer sent a similar letter to Federal Trade Commissioner Lina Khan in August 2023, asking to establish a meeting to discuss the FTC’s monitoring of VBM activities. The FTC did not respond to the Washington Examiner’s request for comment on the 2023 request from Comer.
The Republican committee chairman told Garland in Monday’s letter that the “consolidation and anticompetitive practices” of the VBM market are similar to the practices of pharmacy benefits managers, which also use vertical integration tactics that constrain consumers and restrict competition.
Over the past several years, there has been significant bipartisan support for PBM reform in an effort to lower prescription drug prices. Passage of PBM reform legislation is likely to be on the agenda in both chambers of Congress during the lame-duck session between the election and the end of the year.
Comer’s letter could signal a new area of bipartisan effort on healthcare reform even with the Republican trifecta win in the 2024 elections, taking the majority in both the House and Senate.
The Dentist and Optometric Care Access Act, introduced by Rep. Buddy Carter (R-TN), has been with the House Energy and Commerce Committee since March 2023 and would restrict the ways that insurance companies could offer financial incentives to healthcare providers to sell particular products and services to their patients.
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Garland and Khan have aggressively investigated PBMs and pharmaceutical companies for possible antitrust violations, but it is unclear whether President-elect Donald Trump’s attorney general nominee, former Rep. Matt Gaetz, will continue to pursue this as a priority if confirmed.
The Justice Department did not respond to the Washington Examiner’s request for comment.