Congress Moves to Rein in PBMs — Will Drug Prices Really Fall?

Politico – Online Article – February 3, 2026

After years of stalled efforts, Congress is close to passing bipartisan legislation aimed at lowering prescription drug prices by reforming pharmacy benefit managers (PBMs)—the powerful intermediaries between drug manufacturers, insurers, employers, and pharmacies.

The legislation, included in a major federal funding package, reflects growing concern that PBM compensation models contribute to rising drug costs rather than controlling them.

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What the Legislation Does

The bill focuses on two major reforms:

1. Delinking PBM Compensation

For Medicare Part D plans, PBMs would no longer be paid based on drug rebates or list prices. Instead, they would receive a flat, fair-market-value service fee—removing incentives tied to higher prices.

2. Greater Rebate Transparency

PBMs would be required to pass negotiated rebates back to plan sponsors, increasing visibility into how drug prices are set and how savings are distributed.

Supporters argue these changes better align incentives and could reduce pressure to favor higher-priced drugs.

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Why the Impact May Be Limited

Despite the headlines, experts caution that the bill’s real-world impact may be modest:

• Delinking applies mainly to Medicare Part D, not the much larger commercial insurance market

• Provisions tying patient out-of-pocket costs to lower net prices were removed

• Major PBMs have already adjusted business models in anticipation of reform

Three insurer-owned PBMs still control about 80% of the market, raising ongoing concerns about competition and pharmacy access.

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A First Step — Not the Finish Line

While the legislation represents meaningful progress, many policymakers and analysts describe it as a starting point, not a solution. PBMs are already exploring new revenue streams, including cost-plus pricing models and specialty pharmacy expansion.

As one expert put it, PBM reform remains a “Whac-a-Mole” challenge—requiring continued oversight to prevent cost-shifting and market consolidation.

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RescueMeds’ Perspective

At RescueMeds, we support reforms that improve transparency, protect patients, and ensure fair access for independent pharmacies. Lower drug prices require more than surface-level changes—they demand sustained accountability and competition.

This bill moves the conversation forward, but more work remains.