Congressional leaders announced a bipartisan agreement on Tuesday to overhaul pharmacy benefit managers (PBMs) and increase funding for community health centers, marking a rare cross-party effort to address rising healthcare costs.
The package, which is attached to a broader government funding measure, seeks to implement long-sought reforms to the way intermediaries between drugmakers, insurers, and employers operate. A key provision, championed by Senators Bill Cassidy (R-La.) and Bernie Sanders (I-Vt.), would prohibit PBMs from earning revenue from drug rebates.
Proponents argue the current opaque negotiation process allows PBMs to retain discounts intended for consumers to boost their own profits. Senator Cassidy stated the reforms would “rein in healthcare middlemen, make prescription drugs more affordable and increase access to lifesaving treatments.” The deal also aligns with recent demands from President Donald Trump for increased insurance transparency and an end to PBM “kickbacks.”
Despite support from House and Senate GOP leadership, the bill faces significant obstacles from both industry lobbyists and fiscal hawks. The Pharmaceutical Care Management Association (PCMA), a major trade group representing PBMs, slammed the rebate provision, warning it would limit flexibility and could lead to higher drug prices.
The industry has historically been successful in defeating similar proposals, having spent approximately $47 million on lobbying since 2023. Some pharmaceutical lobbyists suggest the current proposal may not be a “game changer,” noting that major firms like UnitedHealth, Cigna, and CVS have already begun overhauling their pricing models to anticipate potential regulation.
Within Congress, conservative hard-liners may threaten the effort.
Representative Eric Burlison (R-Mo.) criticized the rebate ban as going “way too far over the line,” while others may use the House GOP’s slim margins to block the funding measure on procedural grounds.
The deal arrives as healthcare affordability becomes a central issue for the upcoming midterm elections. Democrats have criticized Republicans for the expiration of enhanced Affordable Care Act (ACA) subsidies last December, which has led to skyrocketing premiums for millions of Americans.
While the new package does not include an extension of those subsidies, some Democrats believe the PBM reforms are too critical to abandon. Lawmakers are also eager to avoid a repeat of December 2024, when a similar effort was torpedoed after public criticism from billionaire Elon Musk.
The proposed legislation also includes extensions for various public health programs, though some Republicans, such as Representative Chip Roy (R-Texas), remain skeptical, arguing the measures may only “shuffle the deck chairs” rather than provide transformational change.