PBM Reform Should be at the Top of Congress' Fall Agenda

As Congress returns this fall, there are likely several items on their “To Do” list – addressing healthcare costs should be near the very top. When it comes to drug pricing reforms, Americans of all backgrounds and political beliefs are united: the system needs to change. With healthcare costs climbing and medical debt burdening millions, addressing harmful PBM practices is a commonsense place to start.

National polls conducted ahead of the 2024 election revealed a striking level of agreement: 90% of voters believe PBMs must be regulated to ensure they provide value and lower drug costs. Four out of five likely voters said PBM regulation should be a high priority for Congress and state legislatures, with more than a third calling it a top priority. In today’s political climate, few issues garner this kind of consensus, making PBM reform a clear opportunity for lawmakers to deliver real relief.

This unity isn’t abstract; it comes from the real-world consequences of PBMs across our healthcare system. From patients at the pharmacy counter to independently owned community pharmacies struggling to survive, PBM practices impact everyone. The numbers tell the story:

• In 2024 alone, more than 1,000 independent pharmacies closed their doors, leaving entire communities without access to vital medications.

• Meanwhile, PBM-owned pharmacies make 18 to 109 times more profit on drugs compared to community pharmacies, all while patients face rising costs.

• PBMs now take 42 cents of every dollar spent on brand-name prescription drugs.

• Pharmacies were hit with $9.1 billion in PBM fees in 2019, compared to $229 million in 2013.

• PBM-affiliated pharmacies mark up some specialty generic drugs by more than 1,000%.

The consensus surrounding PBMs is clear: the longer PBM abuses go unchecked, the higher costs will climb for patients, pharmacies and taxpayers.

PBM reform policies like de-linking PBM revenues from drug prices, ending PBMs’ spread pricing practice and ensuring transparency unite Democrats, Republicans and Independents alike. Lawmakers have a rare chance to rein in middlemen, protect patients and restore fairness to the system.

The choice is simple: Congress can pass PBM reform and deliver relief or allow unchecked PBMs to keep driving up costs and limiting access to care. Americans have spoken. PBM reform isn’t just popular – it’s necessary – Congress should check it off the list this year.