Patients Rising, a national non-partisan patient advocacy organization representing thousands of patients across the country, praised a bipartisan coalition of lawmakers for sponsoring the PBM Reform Act of 2025.

Advocates say that the landmark legislation would end abusive practices by pharmacy benefit managers and substantially lower out-of-pocket costs for millions of patients.

“PBMs have turned life-saving medications into a shell game of hidden fees and broken promises, leaving patients to pay the price,” said Terry Wilcox, Co-Founder and Chief Executive Officer of Patients Rising. “The bipartisan PBM Reform Act stops PBMs’ abusive business practices that increase the financial burden on patients.”

The bipartisan bill, authored by Rep. Earl L. “Buddy” Carter (R-GA) and 11 co-sponsors, targets pharmacy benefit managers, commonly known as PBMs, that drive up drug costs and limit patient access to medications.

Pharmacy Benefit Managers: Health Care’s Costly Middlemen

Pharmacy benefit managers act as middlemen managing every aspect of the prescription drug benefits process for health insurance companies, self-insured employers, labor unions, and government programs. PBMs set prescription costs, decide what drugs are covered by insurance plans and in what order those drugs are placed on the formulary, as well as determine how those drugs are dispensed.

“Local pharmacies and the patients they serve are at a breaking point, and they deserve relief,” said Rep. Diana Harshbarger, one of the bill’s co-sponsors.

In the current healthcare landscape, the three biggest PBMs control more thab 80% of the prescription drug market. Patients Rising has documented heartbreaking cases of PBM abuses nationwide.

• Sarah, a 32-year-old with rheumatoid arthritis, watched her medication costs jump from $50 to $500 per month. Her PBM moved her drug to a higher tier. “I had to choose between paying rent and managing my pain,” she said.
• Michelle, a cancer survivor, faced a similar problem. Her PBM made her pay $60 for a prescription that cost only $40 without insurance. “Why should using my insurance make the medication more expensive?” Michelle asked.
• John, a diabetic, was forced to switch to a less effective insulin. His PBM removed his preferred brand from the formulary. “I spent months trying to stabilize my blood sugar levels,” he said.

PBM Reform Act: Long Overdue Reforms

The PBM Reform Act includes several long-overdue reforms that Patients Rising has championed for years:

• Bans Spread Pricing in Medicaid: PBMs will no longer be allowed to engage in spread pricing, where patients are charged more than the reimbursement amount.
• Delinking PBM Compensation from Drug Prices: Removes incentives that reward PBMs for choosing high-cost drugs over affordable alternatives under Medicare Part D.
• New Transparency Requirements: Requires semi-annual reporting on rebates, drug spending, and formulary decisions to promote transparency.
• Enhanced Oversight: Bolsters the Centers for Medicare and Medicaid Services authority to define and enforce fair contract standards between PBMs and pharmacies.

The legislation has strong bipartisan backing with 11 co-sponsors: Reps. Debbie Dingell (D-MI), Greg Murphy (R-NC), Deborah Ross (D-NC), Jodey Arrington (R-TX), Diana Harshbarger (R-TN), Vicente Gonzalez (D-TX), Rick Allen (R-GA), Raja Krishnamoorthi (D-IL), John Rose (R-TN), Derek Tran (D-CA), and Nicole Malliotakis (R-NY).

“This corruption of the health care delivery system must stop,” said Rep. Greg Murphy, M.D. “I am proud to support this bipartisan legislation to put an end to the extortion and lower drug costs through increased transparency and competition.”

Rep. Buddy Carter Delivers for Patients

As a pharmacist-turned-lawmaker, Rep. Carter brings firsthand insight into how PBMs have manipulated the healthcare payment system.

“It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades,” Rep. Carter said in a press release. “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.”

Patients Rising is working to mobilize patients nationwide to support the comprehensive PBM reform.

“This legislation brings hope to the millions of Americans trapped in a broken system,” Wilcox concluded. “Patients Rising stands ready to work with Congress to ensure the PBM Reform Act becomes law and delivers the relief patients desperately need.”