OPINION:
Shannon, a pharmacy technician, describes the challenges Americans have been facing with the high cost of prescription medications: “I cannot even count the number of times I have heard someone walk away saying, ’I can’t afford this.”’
This is unacceptable, and under President Donald Trump, Congress agreed: Something must change.
That’s why we passed my PBM Reform Act as part of the Consolidated Appropriations Act, 2026.
The PBM Reform Act, which I introduced earlier this year with a bipartisan group of colleagues, reins in pharmacy benefit managers (PBMs). The top three PBMs process nearly 80% of all prescription drugs dispensed by pharmacies. These PBMs have been manipulating drug prices and restricting access to affordable medication for their own financial benefit for decades. With this legislation, we took measurable steps to address the root causes of predatory practices that are negatively affecting Americans’ health and bank accounts.
PBMs have strayed far from their original purpose, which was using their buying power to achieve lower prescription drug costs for employers and consumers. Today, by contrast, PBMs, owned by insurers in vertically integrated conglomerates, drive up prices by controlling drug formularies and steering patients toward higher-priced drugs. PBMs often prefer high list price medicines that enable them to collect larger rebates from manufacturers while at the same time restricting patient access to less expensive drugs like generics and biosimilars.
The PBM Reform Act corrects this bad practice by delinking PBM compensation from drug costs. Paying PBMs a fair, flat, market-based fee for their services eliminates this perverse incentive and ends the practice of these middlemen getting between patients and their physicians by deciding which medications a patient can or cannot take.
This bill also protects community pharmacies by requiring the Centers for Medicare and Medicaid Services to define and enforce “reasonable and relevant” contract terms in Medicare Part D pharmacy contracts. This means PBMs can no longer run roughshod over the small businesses that serve patients every day.
Additionally, the bill mandates a long-overdue higher level of transparency from the PBMs so employers and patients will be able to see how PBMs structure drug costs and determine formularies. For too long, these massively profitable companies have hidden their practices behind an opaque shield to prevent patients and pharmacists from understanding how the money flows. Under President Trump, those days are over.
Let me be clear: This is not the end of the road. Congress still must focus on banning the practice of “spread pricing” in which PBMs reimburse pharmacies less than what they charge health plans for the same medications, pocketing the spread as profit. This practice is pushing too many community pharmacies, often the most accessible or only health care providers for many patients in rural or underserved areas, out of business.
When a pharmacy closes, a community loses a vital health care resource. We need to use every available tool to bring an end to PBM practices that are forcing these small business owners to close their doors for good.
By passing the PBM Reform Act, we are shifting power back to patients and consumers and making an immediate impact on lowering their prescription drug costs.
Patients fought long and hard for this change. There is still a lot more work to be done, but I’m proud that under unified Republican leadership, we are building a health care system that puts patients ahead of profits.
• Rep. Buddy Carter is a Republican representing the First Congressional District of Georgia. As a former small businessowner and pharmacist, he ran and operated his own chain of retail pharmacies for more than 30 years.
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