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A federal funding bill passed the House on Thursday that includes pharmacy benefit manager reform.
Rep. Earl L. “Buddy” Carter (R-GA) was key in getting passage of the PBM Reform Act as part of the Consolidated Appropriations Act 2026.
Should the budget get final passage and approval, conditions in the bill would mean increased transparency and lower healthcare costs by reforming the PBMs, according to Carter.
“As a pharmacist from coastal Georgia, I came to Congress with the goal of building a health care system that put patients before profits,” Carter said. “PBMs have been stealing hope and health from the American people for decades, inflating prescription drug costs, forcing pharmacy closures, and blocking access to medications. To that I say: Not on my watch. The PBM mafia has officially been put on notice. I call on the Senate to pass this bill and help build a quality, accessible, and affordable health care system for patients.”
The bill would prohibit PBM compensation in Medicare Part D from being tied to the manufacturer’s list price of a drug.
To promote price transparency for prescription drugs purchased by employer health plans, PBMs would be required to provide group health plans and issuers with detailed data on drug spending at least semi-annually. This would include data on gross and net drug spending, drug rebates, spread pricing arrangements, formulary placement rationale and information about benefit designs that encourage the use of pharmacies affiliated with PBMs, according to Carter.
It would require the Centers for Medicare & Medicaid Services to define and enforce “reasonable and relevant” Medicare Part D contract terms, including information about reimbursement and dispensing fees. It would establish an appeals process for pharmacies to dispute terms that do not follow the standards.
CMS would have enforcement authority to impose monetary penalties. The agency would receive $188 million for implementation.
Email the writer: SMorse@himss.org