Carter celebrates passage of his key PBM reforms to lower costs for patients

WASHINGTON, D.C. - Rep. Earl L. "Buddy" Carter (R-GA) today celebrated House passage of key portions of his PBM Reform Act as part of the Consolidated Appropriations Act, 2026. After more than a decade of advocacy, Rep. Carter's efforts have resulted in a major win for patients and pharmacies that will increase transparency, preserve patient access to pharmacies, and lower health care costs by reforming the middlemen - pharmacy benefit managers (PBMs).

"As a pharmacist from coastal Georgia, I came to Congress with the goal of building a health care system that put patients before profits," said Rep. Carter. "PBMs have been stealing hope and health from the American people for decades, inflating prescription drug costs, forcing pharmacy closures, and blocking access to medications. To that I say: Not on my watch. The PBM mafia has officially been put on notice. I call on the Senate to pass this bill and help build a quality, accessible, and affordable health care system for patients."

Included in this funding package are Rep. Carter's policies to:

• Prohibit PBM compensation in Medicare Part D from being tied to the manufacturer's list price of a drug in an effort to reduce drug prices and save money for taxpayers.

• Promote price transparency for prescription drugs purchased by employer health plans by ensuring PBMs provide group health plans and issuers with detailed data on prescription drug spending at least semi-annually. Such data includes gross and net drug spending, drug rebates, spread pricing arrangements, formulary placement rationale, and information about benefit designs that encourage the use of pharmacies affiliated with PBMs. The section also ensures that health plans and individuals can receive a summary document regarding information about the plan's prescription drug spending.

• Require the Centers for Medicare & Medicaid Services (CMS) to define and enforce "reasonable and relevant" Medicare Part D contract terms, including information about reimbursement and dispensing fees, and establish an appeals process for pharmacies to dispute terms that do not follow the reasonable and relevant standards. CMS also has enforcement authority to impose monetary penalties, and CMS will receive $188 million for implementation.

• Promote transparency by allowing CMS to track payment trends to pharmacies and pharmacy inclusion in PBM networks, including a designation of essential retail pharmacies.

The PBM provisions included in the Consolidated Appropriations Act, 2026, boast support from key stakeholders.

"The PBM Accountability Project commends Representative Carter's leadership in advancing meaningful PBM reforms. His efforts to increase transparency, curb abusive middleman practices, and protect patients and independent pharmacies are a critical step toward lowering prescription drug costs at the pharmacy counter and restoring accountability to the drug pricing system," said Mark Blum, Managing Director of the PBM Accountability Project.

"For independent community and long-term care pharmacies, the PBM reforms included in this package are as welcomed as they are long overdue. We're grateful for the doggedness of pharmacy champions like Rep. Cater in advancing them through House, and look forward to getting this through the Senate and to the president's desk as quickly as possible. Independent pharmacies and the patients they treat need relief from PBM manipulations, and they need it soon," said Anne Cassity, Senior Vice President of Government Affairs, National Community Pharmacists Association (NCPA).

"The bill contains long-overdue, urgently-needed pharmacy benefit manager (PBM) middleman reforms that are crucial for reducing Americans' drug costs and preserving access to their trusted pharmacies - which are being forced to close at an ever-accelerating rate," said Steven C. Anderson, National Association of Chain Drug Stores (NACDS) President and CEO. "The PBM reforms are essential for seniors in Medicare and for their pharmacies. These reforms would advance the clear priority of Congress and the Trump Administration to bring down peoples' drug costs, to bring healthcare more in-reach for all Americans, and to confront the PBM middlemen's exorbitant profit-grabbing at the expense of taxpayers, all people, and local pharmacies. This bill must be enacted with these PBM reforms without delay."

"Congress stands at the precipice of passing the most important legislation in history to reform the pharmacy benefit management industry. For too long, giant PBMs have taken advantage of their own clients - America's employers and purchasers - to drive their own profits at the expense of working families. The comprehensive PBM reform legislation mandates end-to-end transparency, finally giving employers the information they need to ensure their employees and families are receiving the best price on drugs. Critically, the bill requires PBMs to transparently pass on all rebates and discounts to plan sponsors, ensuring that employers are paying a fair price for drugs and PBMs are only being paid on value added services," said Shawn Gremminger, MPP, President and CEO, National Alliance of Healthcare Purchaser Coalitions.

"Enacting the PBM reform measures in H.R. 7148 would be a significant and long-awaited step forward for patients and pharmacies. It is time to hold the PBMs accountable and put an end to abusive PBM practices that steer patients towards pricier drugs, charge steep markups on medicines and extract billions of dollars in hidden fees," said Mike Stigers, Wakefern Food Corp. President.

"Affordable access to medications is essential for people with MS to manage their disease and live their healthiest lives. We continuously hear from those with MS on the challenges they face in getting their life-changing medications," said Steffany Stern, VP of Advocacy, National MS Society. "The PBM reform provisions included in the minibus package are important steps in putting patients first and bringing much needed transparency to opaque business practices. We applaud Representative Carter for his longstanding leadership in championing bipartisan reforms to support patients."

Read full bill text here.

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