Pharmacy Benefit Managers (PBMs) sit at the center of the prescription drug supply chain, and for years, patients have felt the consequences of their unchecked power. Instead of supporting patient access, PBM practices often create barriers, increase costs, and undermine patient treatment decisions.
PBM business practices too often prioritize profit over patient health. From restrictive formularies and step therapy to opaque rebate systems and accumulator programs, PBMs routinely insert themselves between patients and their medications. These policies delay care, force treatment failures, and shift more of the financial burden onto people with chronic and complex health needs.
What Congress Must Do to Protect Patients
With bipartisan agreement that PBM reform is overdue, Congress has a critical opportunity to enact policies that finally put patients first. CCPA urges lawmakers to advance comprehensive reforms that deliver meaningful relief.
- Increase Transparency in PBM Operations: Require disclosure of pricing structures, rebate flows, and contracting practices to ensure savings reach patients, not increase PBM bottom lines.
- Guarantee That Discounts and Rebates Benefit Patients: Patients should never pay full list price while PBMs retain undisclosed rebates. Congress must mandate that negotiated savings be shared with patients.
- Incentivize Care, Not Profits: Delink PBM compensation from drug list prices and rebate volumes. This ensures coverage decisions are driven by what benefits patients, not what maximizes profit.
- Limit Harmful Utilization Management: Curb excessive prior authorization, step therapy, adverse tiering, and other policies that undermine clinical decision-making and delay access to treatment.
- End Copay Accumulator Policies: Advance patient-centered reforms to ensure copay assistance counts toward deductibles and out-of-pocket limits.
- Strengthen Oversight and Accountability: Include strong enforcement mechanisms to prevent abusive PBM practices and ensure PBMs act in the best interest of patients, providers, and health plans.
Federal Legislation Reflects Growing Bipartisan Attention
CCPA is encouraged to see a growing, bipartisan focus in Congress on addressing PBM practices that contribute to high patient costs and reduced access to care. Lawmakers across committees and across the aisle are putting forward proposals aimed at increasing transparency, improving affordability, and responding to long-standing concerns about PBM conduct.
While each proposal takes a different approach, the breadth of attention reflects promising momentum on an issue that directly affects millions of patients. Legislative proposals include:
- PBM Reform Act of 2025 (H.R. 4317): A comprehensive PBM reform bill that addresses spread pricing, delinking, transparency, and oversight of how PBMs operate within the drug supply chain.
- Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act (S. 3345): A broad PBM reform bill that includes delinking, reporting requirements, increased accountability and transparency of PBM operations.
- Share the Savings with Seniors Act (H.R. 5509): A Medicare-focused bill that ensures senior patients with chronic medical conditions can directly benefit from the savings that plans and PBMs negotiate on their behalf.
- Pharmacists Fight Back Act (H.R. 6609 / 6610): A PBM reform bill that implements a transparent reimbursement model and protects patients and pharmacies against network exclusions.
- HELP Copays Act (HR. 6423 / S.864): A patient-affordability proposal that would ensure copay assistance counts toward deductibles and out-of-pocket maximums, addressing concerns around accumulator and maximizer programs.