In a letter Friday, several pharmacy groups called on congressional leadership to take action on pharmacy benefit manager reforms.
Organizations included in the letter include the National Association of Chain Drug Stores, the National Association of Community Pharmacists, the Food Industry Association, the National Grocers Association, the American Pharmacists Association and the National Association of Specialty Pharmacy. The letter was addressed to House Speaker Mike Johnson (R-Louisiana), House Minority Leader Hakeem Jeffries (D-N.Y.), Senate Majority Leader John Thune (R-South Dakota) and Senate Minority Leader Chuck Schumer (D-N.Y.).
PBMs have come under widespread scrutiny in recent years due to their vertical integration with insurance companies and their practice of jacking up drug prices. The top three PBMs — CVS Caremark, Cigna's Express Scripts and UnitedHealth Group's Optum Rx — control about 80% of the prescription drug market.
Many efforts have been attempted to reform PBM, but with limited success. For example, in December 2024, the federal government came close to passing a spending bill to crack down on PBMs, but the provision was canceled at the last minute.
“Since Congress nearly won on PBM reform in December 2024 — another missed opportunity that nearly enacted — the damage to pharmacy access for patients and communities has only worsened,” the letter states. “In the months since attempts to help fix the problem failed, pharmacies have closed at an alarming net rate of more than six per day, accelerating from the net closure rate of nearly four per day in 2023 and 2024.”
The organizations added that more than 2,200 pharmacies closed last year alone, and Americans have lost a net loss of more than 13% of pharmacies since January 2018.
“The failure to curb harmful PBM practices is no longer a crisis in the making — it now constitutes an unresolved crisis. … Without PBM reform, drug costs for patients will rise, and as pharmacies close and others are squeezed out of the network, many people will no longer have access to the pharmacy of their choice. Americans want Congress to address these dangers,” they said.
Specifically, the coalition calls for the following reforms:
- Medicaid managed care pharmacy payment reform and a ban on spread pricing, in which PBMs charge payers more than they pay pharmacies for drugs and then keep the difference as profit.
- Requires CMS to define and enforce fair Medicare Part D contract terms and ensure true “any willing pharmacy” participation.
- Prohibits PBM reimbursement in Medicare Part D from being tied to drug list prices.
- Increase transparency of claims and reimbursement practices provided by insurance companies to pharmacies.
“As Congress approaches critical deadlines, we respectfully ask that PBM reform be included in the next appropriate mobility tool or advanced as a standalone measure,” the groups wrote. “Consensus is broad, policies are enacted, and the consequences of inaction are intensifying. We stand ready to assist with swift enactment and implementation.”
The letter comes shortly after a bipartisan bill called the PBM Price Transparency and Accountability Act was introduced in the Senate this month. It includes several provisions, including decoupling PBM reimbursement from negotiated rebates and increasing PBM reporting requirements to Medicare Part D plan sponsors and HHS.
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