Pharmacy Benefit Managers (PBMs) have long played a crucial role in the U.S. health care system, acting as intermediaries between insurers, pharmacies, and pharmaceutical manufacturers. These organizations manage prescription drug benefits, negotiate prices, and determine which medications are covered by insurance plans. PBMs have become the subject of intense scrutiny in recent years. Critics argue that PBMs contribute to rising drug prices by prioritizing profits over patient welfare and engaging in practices that lack transparency. Given the growing concern over these issues, the question is now being asked: Is there still time and political will for Congress to act on PBM reform legislation?
The Growing Concerns Over PBMs
PBMs have become a focal point in the debate over prescription drug costs in the United States. While PBMs negotiate discounts and rebates with pharmaceutical manufacturers, critics argue that these savings are not always passed on to consumers. In practice, PBMs may keep a portion of these rebates or use them to incentivize insurers to choose more expensive drugs over less costly alternatives. This practice raises serious concerns about whether PBMs are working in the best interests of patients or prioritizing their bottom lines.
The consolidation of power within the PBM industry has only exacerbated these issues. Today, three PBMs—CVS Caremark, Express Scripts, and OptumRx—control the majority of the market, reducing competition and giving these companies significant leverage over drug prices. Many believe that this concentration of power has allowed PBMs to wield undue influence, increasing prices higher for consumers and limiting access to more affordable medications.
As these concerns have gained traction, the question of whether Congress will step in to reform PBM practices has become increasingly urgent. Lawmakers from both sides of the aisle have recognized the need for change, but with so many obstacles in the way, it is still unclear if legislative action is possible.
Legislative Efforts and the Current State of Reform
Over the past few years, Congress has seen the introduction of several bills aimed at reforming the PBM industry. Proposed reforms have focused on increasing transparency, limiting harmful pricing practices like spread pricing (where PBMs charge insurers more than they reimburse pharmacies), and ensuring that rebates are passed on directly to consumers. Some bills have also looked at tackling the market dominance of the largest PBMs, with the aim of introducing more competition into the space.
One prominent legislative effort is the Pharmacy Benefit Manager Transparency Act, which would require PBMs to disclose the financial arrangements they make with drug manufacturers and pass on the benefits of negotiated rebates directly to consumers. However, while such proposals have gained attention, the road to meaningful reform remains uncertain.
The Energy and Commerce Hearing: A Sign of Continued Interest?
A key moment in the ongoing debate about PBM reform came on February 26, 2025, when the House Energy and Commerce Committee held a hearing focused on the role of PBMs in prescription drug pricing. The hearing featured testimony from industry experts and PBM executives, highlighting the concerns over the lack of transparency of how PBM practices contribute to high drug prices. This hearing demonstrated that there is still significant interest in tackling PBM reform, particularly among Republican lawmakers.
Republicans, historically aligned with free-market policies, have expressed growing frustration with PBMs, recognizing their influence in shaping the prescription drug market. The Energy and Commerce hearing underscored bipartisan recognition that PBM practices are contributing to rising health care costs. This moment suggests that the issue of PBM reform is still very much on Congress’s radar, with both parties continuing to explore solutions.
Is There Time for Action?
While interest in PBM reform is alive and well in Congress, passing meaningful legislation will not be easy. One major obstacle is the complexity of the issue itself. PBMs are deeply embedded within the health care ecosystem, and any reforms could have far-reaching consequences. For example, requiring PBMs to pass on negotiated rebates directly to consumers could disrupt the entire drug supply chain and potentially increase premiums or affect the availability of certain medications. Navigating these complexities and finding a solution that benefits consumers without disrupting the entire system will be a delicate balancing act.
However, there is still reason for hope. Public frustration with high drug prices continues to grow, and PBMs have become an easy scapegoat in the search for solutions. The Energy and Commerce hearing on February 26th indicated that Congress is still paying attention to the issue, and some states have already implemented successful PBM regulations. These state-level efforts could serve as a blueprint for federal action, demonstrating that reform is not only possible but necessary.
Political Will: Is Congress Ready to Act?
Perhaps the most significant question is whether Congress has the political will to act. Despite bipartisan support for PBM reform, lawmakers face considerable pressure from powerful industry players. This pressure could be enough to slow down or weaken reform efforts, especially as elections approach and political divisions deepen. While public support for lowering drug prices is high, it is unclear whether this support will translate into swift action from Congress.
The recent Energy and Commerce hearing does suggest that there is still political interest in the issue, but whether this interest will turn into concrete action remains uncertain. The challenges of enacting reform are significant, and there may not be enough time for comprehensive legislation before the next election cycle.
Conclusion
While there is growing support for PBM reform in Congress, it remains to be seen if lawmakers can overcome the substantial obstacles in their path. The February 26th Energy and Commerce hearing demonstrates that there is continued interest in addressing PBM practices, particularly among Republicans. However, with industry pushback, political complexities, and the time constraints of the legislative calendar, passing meaningful reform will require both political will and bipartisan cooperation. Whether Congress can muster both remains one of the most pressing questions in the battle for lower drug prices.