House GOP leaders set sights on dental, vision markets following PBM reform

The GAO responded by analyzing 2024 dental plan and vision plan data from the National Association of Insurance Commissioners, according to a new GAO report.

GAO officials told the members of Congress who asked for the analysis that:

◆ The top three group dental insurance issuers in a state have a median share of 66.8% of the state's group dental market.

◆ The top three group vision insurance issuers in a state have a median share of 77.4%.

◆ Market insiders see little evidence of insurer ownership of providers, or "vertical integration," affecting the dental insurance market, but they do see it affecting the vision insurance market.

The GAO did not offer recommendations.

The lawmakers who asked for the report have not yet commented on the results, and the House Energy and Commerce Committee has not yet scheduled any committee or subcommittee hearings on the dental and vision markets.

Carter introduced the Dentist and Optometric Care Access Act of 2025 bill in February.

Carter's bill would prohibit private plans from setting prices for dental care and vision care items and services, except for dental cleanings, "for which the plan does not pay a substantial amount," according to the bill summary.

The bill would also limit how long a plan can contract with a provider for limited scope dental or vision benefits, and it would prohibit a plan from restricting a dental or vision care provider's choice of laboratories or suppliers.

What it means: Employers and benefits advisors who could not imagine themselves being interested in PBMs 10 years ago could soon find themselves getting interested in battles over dental plan and vision plan provider networks.

The report: While analyzing market concentration in the group dental and group vision insurance markets, the GAO created lists showing the insurers with the biggest market share in each state other than Massachusetts.

GAO investigators found, for example, that an affiliate of the Delta Dental organization or the Blue Cross and Blue Shield organization was the state group dental market leader in 30 states.

Delta Dental carriers that were the state market leaders had an average market share of 46% in their states.

Blue Cross and Blue Shield carriers that were the market leaders had an average market share of 39%.

Renaissance was a market leader in eight states, Cigna in three states, MetLife in three states and Guardian in two states.

The investigators excluded data from Massachusetts because there appeared to be problems with the data.

The backdrop: Insurers and insurer groups have been clashing with state legislators over their relationships with dentists and optometrists in state legislatures at the National Council of Insurance Legislators.

Related: Rep. Morgan Griffith takes over key House health benefits post

Lawmakers have been introducing federal dental and vision plan network bills in Congress since at least 2015.

For employer plan sponsors, the considerations have been similar to those affecting major medical plan provider networks and PBM pharmacy networks: Employers want to see plans keep prices as low as possible while also maintaining stable, high-quality networks with enough conveniently located providers to meet plan participants' needs.