PBMs Become Rare Bipartisan Target in Washington and States

Pharmacy benefit managers have found something unusual in polarized Washington: bipartisan agreement that they are a problem. According to KFF Health News, conservative Republicans and Democrats are lining up behind proposals to curb the power of PBMs, the middlemen who negotiate drug prices between manufacturers, insurers, and pharmacies.

The boldest idea would bar companies that own a PBM from also owning retail pharmacies, directly targeting vertically integrated giants like CVS Health, which owns both Caremark and thousands of drugstores. Two states have already enacted such restrictions, KFF reports, and a federal version has attracted prominent sponsors from both parties. The logic uniting them: PBMs use their market position to steer patients, squeeze independent pharmacies, and obscure where drug dollars actually go.

In practice, forced divestiture would reshape the business models of the largest players, which also include Cigna's Express Scripts and UnitedHealth's Optum Rx. Whether the federal effort passes remains uncertain, but the political consensus signals mounting pressure on an industry long shielded by its complexity.