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Congresswoman Debbie Dingell (MI-06) today joined 11 bipartisan members of Congress in introducing the PBM Reform Act, which protects patients and pharmacies from the harmful and anticompetitive business practices of the pharmacy benefit managers (PBMs). 

“For too long, pharmacy benefit managers have been allowed to operate unchecked, raising prices and preventing many patients from getting the medications they depend on,” Rep. Debbie Dingell said. “I hear from too many Michiganders, especially seniors, who can’t conveniently access the prescriptions they need, due to exploitative PBM practices complicating access to their local pharmacies. Their harmful, aggressive tactics are only getting worse, and we must take action now to protect pharmacies and lower patient costs. I remain committed to working with my colleagues on both sides of the aisle to get this across the finish line.”

The PBM Reform Act will: 

Ban “spread pricing” in Medicaid and move to a transparent system that ensures pharmacies are fairly and adequately reimbursed for serving Medicaid beneficiaries.

• Establish new requirements for PBMs under Medicare Part D, including a policy to delink PBM compensation from the cost of medications and increase transparency. 
• Promote transparency for both employers and patients in their prescription drug plans, with semi-annual reporting on drug spending, rebates, and formulary determinations.
• Require Centers for Medicare and Medicaid Services (CMS) to define and enforce "reasonable and relevant" contract terms in Medicare Part D pharmacy contracts and enforce oversight on reported violations.

The PBM Reform Act is cosponsored by Earl L. “Buddy” Carter (R-GA), Greg Murphy (R-NC), Deborah Ross (D-NC), Jodey Arrington (R-TX), Diana Harshbarger (R-TN), Vicente Gonzalez (D-TX), Rick Allen (R-GA), Raha Krishnamoorthi (D-IL), John Rose (R-TN), Derek Tran (D-CA), and Nicole Malliotakis (R-NY). 

“It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades,” said Rep. Buddy Carter. “As a pharmacist, I’ve seen how PBMs abuse patients firsthand, and believe that the cure to this infectious disease is transparency, competition, and accountability, which is exactly what our bipartisan package provides.”

“Unaffordable health care, unclear pricing practices, and a burdensome system that is difficult to navigate has created life-threatening barriers to care for Americans," said Rep. Greg Murphy, M.D. "At the heart of this problem are pharmacy benefit managers (PBMs), middlemen who withhold money from independent pharmacies, obscure drug costs, and make out like bandits, all at the expense of patients. This corruption of the health care delivery system must stop. For years, we have heard from small business owners, physicians, and patients about the damage greedy PBMs have inflicted. I am proud to support this bipartisan legislation to put an end to the extortion and lower drug costs through increased transparency and competition."

“For too long, PBMs have served as unregulated middlemen, driving up prices for life-saving medications for patients,” said Rep. Deborah Ross. “Nobody should have to choose between paying for life-saving medication and putting food on the table. Our bipartisan PBM Reform Act will protect Americans from abusive practices that raise prices and reduce fairness. I’m proud to work with Rep. Carter on these long overdue reforms. It’s past time to hold PBMs accountable and ensure every American can access the medications they need.”

“It’s time to put an end to the shady and manipulative practices of pharmacy benefit managers. For too long, PBMs have driven up drug prices and padded their pockets while independent community pharmacies are being pushed to the financial brink,” said Rep. Diana Harshbarger.  My colleagues and I are committed to changing that. This legislation delivers long-overdue accountability, increases transparency, lowers out-of-pocket costs for families, and saves taxpayer dollars. Local pharmacies and the patients they serve are at a breaking point, and they deserve relief. I’m proud to join my colleagues in introducing this bill and look forward to passing real PBM reform that will deliver for both patients and providers.”

“Pharmacy Benefit Managers line their pockets and drive up the cost of life saving drugs at the expense of South Texans and the community pharmacies they depend on — this is shameful, dangerous, and must be stopped,” said Rep. Vicente Gonzalez. “I’m proud to introduce this bipartisan legislation with Congressman Buddy Carter that puts patients first, increases price transparency, and holds PBMs accountable.”

“PBM reform has long been a pressing issue, not only in rural Georgia, but across the nation,” said Rep. Rick W. Allen. “I am proud to work with Representative Carter on this commonsense package to eliminate the use of spread pricing, make prescription drugs more affordable, and establish rigorous oversight over PBM tactics that threaten access to care. Our health care system is in need of patient-centered, cost-effective, market-driven solutions and this package delivers.”

“I’m proud to co-lead the PBM Reform Act to crack down on abusive practices by pharmacy benefit managers and drive down the cost of prescription drugs for working families,” Rep. Raja Krishnamoorthi said. “This bipartisan legislation brings long-overdue transparency and accountability to the prescription drug supply chain, ensuring patients, not middlemen, come first.”

“Seniors should be able to fill the prescriptions they need without having to drive long distances or pay exorbitant costs," Rep. John Rose said. "For far too long, Pharmacy Benefit Managers (PBMs) have favored large chains and driven away customers from independent pharmacies, especially those in rural communities. I am proud to co-lead this legislation, which will be a gamechanger for countless Tennesseans.”

“Southern California families are seeing their cost-of-living skyrocket, especially the cost of essential health care. I’m laser-focused on bipartisan, common-sense solutions that bring down costs and ensure that our economy works for working families.” said Rep. Derek Tran. “My experience running a community pharmacy with my wife showed me firsthand the urgent need for greater transparency and accountability in how Pharmacy Benefit Managers operate. That is why I’m proud to co-lead this bipartisan effort with Representatives Carter and Dingell to reform PBM practices, increase transparency, and put patients first.”

“I’m proud to join my colleagues in introducing this critical PBM reform package, which cracks down on the exploitative pricing tactics of pharmacy benefit managers to make prescription drugs more affordable,” said Rep. Nicole Malliotakis. “PBMs' shady practices have left consumers footing the bill and are driving many ‘Mom & Pop’ pharmacies in my district out of business. Our legislation will deliver long-overdue reforms to increase price transparency and protect patients. Now is the time for Congress to act and get PBM reform across the finish line.”

Background

Pharmacy benefit managers were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. Over time, PBMs have been allowed to operate virtually unchecked as they consolidated to where three companies now control 80% of the prescription drug market. 

Vertical integration and a lack of transparency have led to pharmacy closures and higher costs for patients across the country.