Rep. Buddy Carter Introduces PBM Reform Act

MedCity News online article – July 14, 2025 —U.S. Rep. Earl L. “Buddy” Carter (R-GA), a licensed pharmacist, has introduced the PBM Reform Act, a bipartisan bill aimed at cracking down on the power of pharmacy benefit managers (PBMs).

The legislation targets industry practices that many say contribute to rising drug prices and reduced transparency in the U.S. healthcare system.

What Is the PBM Reform Act?

The PBM Reform Act includes two key provisions designed to hold PBMs accountable:

1. Ban on Spread Pricing in Medicaid

Spread pricing is a practice where a PBM charges health plans more for a drug than what it pays the pharmacy—then keeps the difference as profit.

This bill would ban spread pricing in Medicaid, helping reduce inflated costs for taxpayers and increase pricing transparency.

2. Delinking PBM Pay from Drug Prices in Medicare Part D

Under the current system, PBMs often earn more when more expensive drugs are prescribed. The PBM Reform Act would “delink” PBM compensation from drug prices, removing the incentive to favor higher-cost medications.

This change would apply to Medicare Part D, aiming to realign PBM incentives with patient health outcomes, not profit margins.

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Why This Matters: PBMs and Market Control

Three major PBMs—CVS Caremark, Optum Rx (UnitedHealth Group), and Express Scripts (Cigna)—control roughly 80% of the U.S. prescription drug market.

Critics argue that this concentrated power allows PBMs to:

• Drive up drug costs

• Limit consumer and pharmacy choices

• Reduce transparency across the supply chain

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Buddy Carter: “Time to Bust the PBM Monopoly”

As a pharmacist, Rep. Carter has long criticized PBMs for putting profits over patients.

“It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades,” Carter said in a recent statement.

“The cure to this infectious disease is transparency, competition, and accountability—which is exactly what our bipartisan package provides.”

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Potential Impact of the PBM Reform Act

If passed, the PBM Reform Act could bring sweeping changes to how prescriptions are priced and managed in the U.S. healthcare system.

Expected Benefits:

• Lower drug costs for patients and public programs

• Increased transparency in drug pricing

• Greater accountability for PBMs

• Support for independent pharmacies facing unfair contract terms

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Final Thoughts

With drug affordability a top concern for millions of Americans, the PBM Reform Act represents a major step toward healthcare reform and cost control. By addressing PBM practices head-on, this bill could help restore fairness and competition in the prescription drug market.

Stay tuned as this important legislation makes its way through Congress.

 

Access DrugTopics Q&A – Congressman Buddy Carter (R-GA) – Highlights PBM Reform Bill