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Source: United States House of Representatives – Congressman Raja Krishnamoorthi (8th District of Illinois)

WASHINGTON – Today, Congressman Raja Krishnamoorthi (D-IL) joined with Congressman Earl “Buddy” Carter (R-GA) and nine other members of Congress to introduce the bipartisan PBM Reform Act, legislation that protects patients and independent pharmacies from harmful business practices used by pharmacy benefit managers (PBMs).

“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,” Congressman Krishnamoorthi said. “This bipartisan legislation brings long-overdue transparency and accountability to the prescription drug supply chain, ensuring patients, not middlemen, come first.”

Specifically, the PBM Reform Act:

• 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.

As Ranking Member of the Health and Financial Services Oversight Subcommittee, Congressman Krishnamoorthi has introduced several pieces of bipartisan legislation aimed at reining in the power wielded by PBMs over patients and small, local, independent pharmacies.

The PBM Reform Act comes just months after a Federal Trade Commission (FTC) interim staff report found PBMs prioritize their own pharmacies over independent businesses and significantly upcharge for specialty generic drugs such as those used to treat HIV, cancer, and other serious medical conditions. These practices have allowed the three largest PBMs to grab control of 80 percent of the prescription drug market, contributing to more than 2,000 local and independent pharmacy closures in 2024. In Illinois alone, 73 percent of counties are classified as pharmacy deserts and have no pharmacies located within 10 miles.

In January, Congressman Krishnamoorthi toured Del-Kar Drugs in the North Lawndale neighborhood of Chicago, where he spoke about how pharmacy closures are hurting people of color. Congressman Krishnamoorthi also cited data that between 2015 and 2020 in Chicago, more than half of pharmacy closures came in majority Black and Latino neighborhoods.

Joining Congressmen Krishnamoorthi and Carter in introducing the PBM Reform Act was Reps. Debbie Dingell (D-MI), Greg Murphy (R-NC), Deborah Ross (D-NC), Jodey Arrington (R-TX), Vicente Gonzalez (D-TX), Diana Harshbarger (R-TN), Derek Tran (D-CA), Rick Allen (R-GA), John Rose (R-TN), 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. 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,” Congressman Carter said.

“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,” Congresswoman 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.”

“Unaffordable health care, unclear pricing practices, and a burdensome system that is difficult to navigate has created life-threatening barriers to care for Americans,” Congressman Murphy, M.D, said. “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,” Congresswoman Ross said. “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. 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,” Congressman Harshbarger said. 

“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,” Congressman Gonzalez said. “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. 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,” Congressman Allen said.

“Seniors should be able to fill the prescriptions they need without having to drive long distances or pay exorbitant costs,” Congressman 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. 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,” Congressman Tran said.

“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,” Congresswoman Malliotakis said. “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.”

MIL OSI USA News –