Warren, Hawley, Harshbarger, Auchincloss Renew Bipartisan Push to Rein in Pharmacy Benefit Managers (PBMs), Cut Drug Costs

Warren, Hawley, Harshbarger, Auchincloss Renew Bipartisan Push to Rein in Pharmacy Benefit Managers (PBMs), Cut Drug Costs

PBM Act picks up key bipartisan cosponsors, including Senators Fetterman and Marshall and representatives on committees of jurisdiction in the House.

Tennessee Governor could sign their version of the PBM Act into law as early as this week.

Text of Bill (PDF) | One-Pager (PDF)

Washington, D.C. - Today, Senators Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.), alongside Representatives Diana Harshbarger (R-Tenn.) and Jake Auchincloss (D-Mass.), reintroduced the Patients Before Monopolies (PBM) Act with expanded bipartisan support, indicating growing momentum for a policy that will prohibit joint ownership of pharmacy benefit managers (PBMs) and pharmacies, a gross conflict of interest that enables these companies to enrich themselves at the expense of patients and independent pharmacies.

In the 119th Congress, new cosponsors include Senators John Fetterman (D-Pa.) and Roger Marshall (R-Kansas), along with Representatives Greg Landsman (D-Ohio) and Buddy Carter (R-Ga.) of the Committee on Energy and Commerce, and Jerry Nadler (D-N.Y.) and Troy Nehls (R-Texas) of the Judiciary Committee. Notably, the PBM Act would pass through the Committee on Energy and Commerce or the Judiciary Committee before reaching the House floor under regular order.

Since this bill was first introduced in 2024, states across the country have sought to break up these giant conglomerates. In early 2025, Arkansas passed a law to prevent the joint ownership of PBMs and pharmacies. Later that year, 39 state attorneys general wrote a letter urging Congress to "pass an act prohibiting PBMs, their parent companies, or affiliates from owning or operating pharmacies." In April, Tennessee lawmakers passed a law to ban joint ownership of PBMs and pharmacies, and the Tennessee Governor is expected to sign the bill into law as soon as this week. This growing bipartisan momentum in support of the goals of the PBM Act from across the nation sends an important signal to Congress that the work to rein in PBMs is not yet finished.

"Our PBM Act is gaining momentum because people are realizing that you can't lower health care costs without tackling corporate greed in the health care system," said Senator Warren. "It's time we finally rein in the health care middlemen that are jacking up drug costs and driving small pharmacies out of business."

"Americans are paying more and more for healthcare while seeing less in return. PBMs are at the center of a broken system that rewards middlemen while driving up costs for patients and pushing out independent pharmacies," said Senator Hawley. "Working Americans deserve better. This legislation is a major step toward restoring transparency and making healthcare more affordable for every American."

"As a lifelong pharmacist, I've seen firsthand how PBMs game the system. When the same corporate giant that sets reimbursement rates also owns the pharmacy collecting them, that's not a free market-it's a rigged one," said Congresswoman Diana Harshbarger. "We have antitrust laws for a reason. When monopolies squeeze out independent pharmacies, raise costs for patients, and reduce consumer choice, Congress has a duty to restore fair competition. The Patients Before Monopolies Act ends this blatant conflict of interest once and for all."

"Like so many small business owners in America, independent pharmacists are working hard and playing by the rules but getting ripped off by monopolies. The PBM industry is rife with self-dealing and price gouging. Congress made modest but meaningful reforms earlier this year, and now the next step is banning PBMs from owning pharmacies. It's an unacceptable conflict of interest and yet another example of the vertical integration in health care that is raising prices for patients," said Congressman Jake Auchincloss.

"Pharmacy Benefit Managers drive prices up for patients and run independent pharmacies out of business. These greedy corporations have dodged regulation at the cost of American patients and small businesses for far too long," said Congressman Jerrold Nadler. "For my entire career, I have fought to make healthcare accessible for all Americans, and I am proud to support this bill reining in PBMs and enforcing fair business practices."

Over the past decade, pharmacy benefit managers (PBMs) - the middlemen between pharmacies and insurance companies - have morphed into large health care conglomerates that exercise control over every link in the prescription drug delivery chain. Today, the largest health care conglomerates each own a PBM - which pay for pharmacy services - as well as the pharmacy chains that provide those services. This inherent conflict of interest results in higher drug costs for patients and fewer independent pharmacies, but bigger profits for the corporate health care giants.

The Patients Before Monopolies (PBM) Act would address this by:

• Prohibiting a parent company of a PBM or an insurer from owning a pharmacy business;
• Requiring that a parent company in violation of the PBM Act divest its pharmacy business within one year;

• Empowering the Federal Trade Commission (FTC), Department of Health and Human Services, Department of Justice (DOJ), state attorneys general, and harmed individuals to enforce the law against violators by requiring them to divest their pharmacy business and disgorge any revenue received during the period of such violation;
• Directing the FTC to distribute any disgorged revenue to harmed communities, including consumers overcharged at vertically integrated pharmacies;
• Authorizing the FTC and DOJ to monitor pharmacy business divestment, and impose monetary penalties if companies drag their feet or fail to comply; and
• Mandating reporting of all divestitures to the FTC, and allowing the FTC to review all divestitures and subsequent acquisitions to protect competition, financial viability, and the public interest.

"PBM vertical integration with retail, mail-order, and specialty pharmacies has led to reduced patient choice and higher drug prices for patients and payers. The Patients Before Monopolies Act cuts out PBM conflicts of interest at their root by breaking up PBM ownership of and affiliation with pharmacies. APCI commends Senators Warren and Hawley, and Representatives Harshbarger and Auchincloss on fighting against PBM anticompetitive practices and advancing policies that will restore competition to the prescription drug marketplace," said Greg Reybold, Vice President of Public Policy, American Pharmacy Cooperative, Inc.

"With the reintroduction of the Patients Before Monopolies Act (PBM Act), we are grateful to Senators Warren and Hawley and Representatives Harshbarger and Auchincloss for standing up for patients and pharmacies. For too long, the largest health insurers have resorted to fear and intimidation tactics, expending substantial resources in order to scare and confuse the public into thinking PBM reform will be bad for them. With this new legislation, PBMs will finally be held accountable for years of abusing their role as "benefits administrators" to undercut pharmacy providers while also profiteering off the backs of unsuspecting employers, patients and taxpayers," said Monique Whitney, Executive Director, Pharmacists United for Truth and Transparency.

"Divesting PBMs from owning pharmacies will stop the conflict of interest that drives patients into PBM-owned specialty pharmacies where specialty generic drug prices are kept artificially high. The Patients Before Monopolies Act levels the playing field for community pharmacists and finally puts patients ahead of PBM profits," said Madelaine Feldman, MD, FACR; Rheumatologist; Vice President, Advocacy & Government Affairs; Coalition of State Rheumatology Organizations.

"Giant PBMs and insurers owning their own pharmacies has driven independent pharmacies out of business and reduced patient access to quality care. The Patients Before Monopolies Act addresses the root cause of this problem - consolidated market power - by eliminating the inherent conflicts of interest within the 'Big Three' PBM business model," said Morgan Harper, Director of Policy and Advocacy at the American Economic Liberties Project. "We are thrilled to see Sen. Warren and Sen. Hawley and Reps. Harshbarger and Auchincloss lead this bipartisan effort to lower drug costs, protect independent retail pharmacies, improve patient access to care, and break up Big Medicine."

"The Patients Before Monopolies Act takes an important step toward restoring integrity and competition in healthcare by ending the deeply flawed model where PBMs and insurers can own the very providers they oversee and reimburse. When the same corporations control the financing, administration, and delivery of care, patients and independent providers are put at a disadvantage. Healthcare decisions should be driven by what is best for patients, not by vertically integrated corporations maximizing profits through self-preferencing and consolidation," said Robert Levin, MD, President, Alliance for Transparent & Affordable Prescriptions.

"American Pharmacies strongly supports the Patients Before Monopolies Act. When PBMs own pharmacies, the resulting self-dealing and conflicts of interest distort the marketplace and too often undermine affordable, accessible, patient-centered care. American Pharmacies and our 700 independent pharmacy members across the country thank the bill's sponsors for their leadership in confronting one of the root causes of rising costs and barriers to care," said Steve Hoffart, R.Ph., Chairman, American Pharmacies.

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