In a Friday letter, a group of pharmacy organizations called on Congressional leadership to take action on pharmacy benefit manager reform.
The organizations included in the letter are the National Association of Chain Drug Stores, the National Community Pharmacists Association, 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-New York), Senate Majority Leader John Thune (R-South Dakota) and Senate Minority Leader Chuck Schumer (D-New York).
PBMs have come under a lot of scrutiny in recent years due to their vertical integration with insurers and practices that inflate 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.
Numerous efforts have been attempted to reform PBMs, though with little success. For example, in December 2024, the federal government almost passed a spending bill that would have cracked down on PBMs, but this provision was taken out at the last minute.
“Since Congress’ near‑win on PBM reform in December 2024 — another missed opportunity that fell just short of enactment — the devastation of pharmacy access for patients and communities has only worsened,” the letter stated. “In the months since that lost attempt to help solve the problem, pharmacies have closed at an alarming net rate of more than six per day, an acceleration of the nearly four-per-day net closing rate of 2023 and 2024.”
The organizations added that in just the last year, more than 2,200 pharmacies have closed and Americans have lost more than 13% of their pharmacies since January 2018 on a net basis.
“The failure to curb harmful PBM practices is no longer a crisis in the making — it now constitutes a crisis unaddressed. … Without PBM reform, patients are experiencing inflated drug costs, and many no longer have access to the pharmacy of their choice as pharmacies close and others are pushed out of network. Americans expect Congress to address these perils,” they said.
Specifically, the coalition called for the following reforms:
- Medicaid managed care pharmacy payment reform and a ban on spread pricing, in which a PBM charges payers more than they pay the pharmacy for a medication and then keeps the difference as profit.
- Requiring CMS to define and enforce fair Medicare Part D contract terms and ensure true “any willing pharmacy” participation.
- Banning PBM compensation in Medicare Part D from being linked to the list price of a drug.
- Promoting greater transparency in insurer claims and reimbursement practices provided to pharmacies.
“As Congress approaches key deadlines, we respectfully request that PBM reform be included in the next appropriate moving vehicle or advanced as a stand‑alone measure,” the organizations wrote. “The consensus is broad, the policy is developed, and the consequences of inaction are compounding. We stand ready to assist with swift enactment and implementation.”
This letter comes shortly after a bipartisan bill was introduced in the Senate this month called the PBM Price Transparency and Accountability Act. It includes several provisions, including delinking PBM compensation from negotiated rebates and increasing reporting requirements for PBMs to Medicare Part D plan sponsors and HHS.
Photo: gerenme, Getty Images
