Congress Moves to Reform Pharmacy Benefit Managers to Lower Prescription Drug Prices

Politico – Online Article – February 3, 2026

After years of debate, Congress is close to passing reforms aimed at lowering prescription drug prices. The legislation targets pharmacy benefit managers (PBMs), the intermediaries that negotiate drug prices between drug manufacturers, insurers, and pharmacies.

The proposed changes are part of a $1.2 trillion federal funding package recently passed by the Senate and now under consideration by the House.

Lawmakers from both parties say the goal is simple: bring more transparency to the prescription drug supply chain and reduce costs for patients.

According to Senate Finance Committee Chair Mike Crapo, the bipartisan legislation could lead to lower prices for seniors at the pharmacy counter.

However, policy experts say it is still unclear whether the reforms will significantly reduce drug costs for most Americans.

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Why Congress Is Targeting PBMs

PBMs play a powerful role in the prescription drug system.

They negotiate drug rebates with pharmaceutical manufacturers. They also determine which medications appear on insurance formularies and which pharmacies participate in preferred networks.

Critics argue the current PBM payment model creates problematic incentives.

Many PBMs earn revenue based on the rebates they negotiate with drug manufacturers. These rebates are often tied to a drug’s list price.

As list prices increase, rebate amounts may also increase. Critics say this structure can reward higher drug prices rather than lower ones.

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A Key Reform: Delinking PBM Compensation

The proposed legislation introduces a policy known as “delinking.”

This change would apply to Medicare Part D plans.

Under the new model, PBM compensation would no longer depend on the size of rebates or list prices. Instead, PBMs would receive a fixed administrative fee based on fair market value.

Lawmakers hope this will remove incentives tied to higher list prices.

The bill also requires PBMs to pass negotiated rebates to commercial plan sponsors, such as employers.

However, the legislation does not require delinking for commercial insurance plans, which means many PBM business practices could continue unchanged in that market.

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Industry Response and Market Power Concerns

PBMs have faced growing scrutiny from lawmakers and independent pharmacies.

Today, three companies dominate the PBM industry:

• Express Scripts (owned by Cigna)

• Optum Rx (owned by UnitedHealth Group)

• CVS Caremark (owned by CVS Health)

Together, these companies control roughly 80% of the PBM market.

Critics argue this level of consolidation reduces competition. It may also make it harder for independent pharmacies to participate in preferred pharmacy networks.

Some PBMs have already started adjusting their business models.

For example, Cigna announced plans to eliminate traditional rebate structures within Express Scripts.

Other PBMs are shifting toward “cost-plus” pricing models. Under this approach, insurers pay the cost of a drug plus an administrative fee.

Supporters say this approach is simpler. Critics argue it still lacks full transparency.

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Will PBM Reform Lower Drug Prices?

The legislation represents one of the most significant federal efforts to regulate PBMs.

However, the real impact on drug prices remains uncertain.

Some analysts believe the largest PBMs have already adapted their business models in anticipation of new regulations.

If that is the case, the reforms may have a smaller effect on pricing than lawmakers hope.

At the same time, pharmaceutical manufacturers argue that limiting PBMs’ negotiating flexibility could increase costs in some situations.

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What It Means for Patients and Independent Pharmacies

Even if price reductions are modest, the legislation reflects growing concern in Washington about the lack of transparency in the drug supply chain.

Greater transparency could help patients, employers, and regulators better understand how prescription drug prices are set.

For independent pharmacies, reforms that improve transparency and fairness could help protect patient access to medications.

That is especially important for patients with complex medical needs, including injured workers, first responders, and those managing chronic conditions.

As policymakers continue to examine PBM practices, transparency and patient access will likely remain at the center of the debate.