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Transparency in drug pricing: A closer look at Congressional PBM reform.

Congress is targeting rising prescription drug costs through PBM reform. Explore the legislative efforts driving PBM transparency.


Pharmacy benefit managers (PBMs) serve as intermediaries between drug manufacturers, pharmacies, plan sponsors, and patients. Originally created to negotiate favorable terms and maintain affordable prescription drug costs, PBMs have gradually strayed from their intended mission. Instead, they've become entangled in opaque practices that drive up drug costs for employers and their teams.

As concerns over rising drug prices grow, the U.S. Congress has introduced several bills to curb the unchecked practices of PBMs. These legislative measures aim to bring transparency to an industry known for its secrecy, with a focus on the "big 3" PBMs that control 80% of the market.

Understanding the push for PBM reform.

At the heart of the legislative agenda lies an effort to overhaul shady PBM practices, addressing key concerns such as profiting from rebates and lack of transparency. The legislation also targets spread pricing, a tactic where PBMs charge plan sponsors more for a prescription drug than what they pay back to the pharmacy. By mandating full disclosure of fees across the supply chain, Congress aims to foster a fairer, more transparent marketplace for prescription drugs. Let's dive into the specifics of some of the pivotal bills under consideration:

Despite legislative efforts striving to bring about a new era of affordability and accessibility in prescription drug pricing, change can’t come soon enough. Fortunately, you can take proactive steps by partnering with a transparent PBM that prioritizes passing back savings to employers and members. With audit-level reporting, Rightway sets a new standard in PBM transparency, ensuring that every dollar saved is returned to you and your teams. 

Uncover a new level of PBM transparency today with Rightway. Learn more here.

Bills are long, dynamic, and far-reaching. This overview covers some of the current legislation as of March 2024. It summarizes portions of the bills that would impact PBMs working with self-insured employers.

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