2025 Year in Review: Advancing the Case for PBM Accountability

As 2025 comes to a close, one thing is clear: momentum for PBM reform is stronger than ever. Over the past year, patients, pharmacists, employers and policymakers have increasingly recognized what the PBM Accountability Project (PBMA) has long worked to expose. The current PBM middleman system drives up costs, limits patient choice and operates with far too little transparency. The growing recognition for PBM accountability translated into meaningful action at both the state and federal levels, setting the stage for a year defined by heightened scrutiny and reform efforts. 

State-Level Action 

Throughout the year, legislative action across states has taken direct aim at PBM practices and advancing reforms that increase transparency. States passed a series of reforms targeting PBM practices that harm independent pharmacies and obscure drug pricing. Arkansas enacted a first-in-the-nation ban on PBMs owning or operating pharmacies. Other notable actions include laws in Colorado and California to prohibit tying PBM pay to drug prices and alter PBM pay to flat-fee models. These reforms reflect a growing belief among state policymakers that more oversight is needed to protect patients and local pharmacies. 

Federal Legislative Developments 

State and advocacy momentum has also carried over to Capitol Hill, where Senate Finance Committee Chairman Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) introduced the PBM Price Transparency and Accountability Act. This bipartisan legislation aims to realign incentives in federal drug programs by increasing reporting requirements, disconnecting PBM compensation from negotiated rebates, strengthening pharmacy access protections and promoting clearer cost transparency to help lower prices at the pharmacy counter.  

Looking Ahead to 2026 

As we look ahead to 2026, the case for PBM reform remains urgent. As new bipartisan proposals in Congress and state policies are enforced, the PBM Accountability Project remains committed to building on this progress through continued education, advocacy and engagement. 

Most importantly, we will continue working to ensure patients, employers and policymakers understand why PBM reform is urgently needed and why Congress must act now to bring transparency, accountability and fairness to the prescription drug system. 

Learn more about policy solutions here and see highlights of 2025 from PBMA in our latest newsletter.