Blackburn, Hassan, Colleagues Introduce the “Patients Before Middlemen Act” to Bring Down Cost of Prescription Drugs
March 6, 2025
WASHINGTON, D.C. – Today, U.S. Senators Marsha Blackburn (R-Tenn.), Maggie Hassan (D-N.H.), and Mark Warner (D-Va.) released the following statements after introducing the Patients Before Middlemen (PBM) Act, which would delink the compensation of pharmacy benefit managers (PBMs) from drug price and utilization. It would also ensure fair treatment of all pharmacies by requiring Medicare Part D plans to contract with any willing pharmacy that meets reasonable terms and conditions.
“The Patients Before Middlemen Act would increase transparency and reduce prescription drug costs for seniors at the pharmacy counter. For too long, middlemen have taken advantage of misaligned incentives in the pharmaceutical supply chain at the expense of taxpayers and seniors. We need to put patients before the profits of pharmacy benefit managers,” said Senator Blackburn.
“Seniors shouldn’t have to choose between paying for essential medications and other basic needs,” said Senator Hassan. “This bipartisan legislation will help stop pharmacy benefit managers from exploiting loopholes that allow them to drive up drug prices, saving seniors their hard-earned money while also saving taxpayer dollars. I urge my colleagues to support this bill, and I will continue to work to lower prescription drug costs for Granite Staters and all Americans.”
“For too long, Seniors on fixed incomes have had to worry about the high cost of prescription drugs. Meanwhile, PBMs continue to contribute to this phenomenon by keeping drug prices high and reimbursements for local pharmacies low. Seniors on Medicare – and the Medicare program itself – can’t afford to be taken advantage of by middlemen who don’t contribute to quality of care. I’m proud to introduce this legislation as part of our ongoing fight to get these policies across the finish line,” said Senator Warner.
Senator James Lankford (R-Okla.) co-sponsored this legislation.
BACKGROUND
- PBMs are third-party intermediaries that manage prescription drug benefits and pharmacy networks on behalf of health plans, including Medicare Part D plans. PBMs perform multiple functions, including determining which medications will be covered by health insurance plans and how much patients will pay.
- The PBM industry was created to assist employers with managing overall prescription drug costs and benefits. However, the current system incentivizes PBMs to steer health plans and seniors towards more expensive prescription drugs.
- Currently, PBMs’ income is often linked to the price of a drug. By tying administrative fees, rebate-based compensation, and other payments to a percentage of the list price, current arrangements incentivize increases in sticker prices, harming patients at the pharmacy counter.
- Existing regulations allow Part D plan sponsors to contract selectively with pharmacies, favoring preferred networks that often exclude independent pharmacies.
THE PBM ACT
The PBM Act would:
- Ensure pharmacies are given fair and equitable treatment by requiring Part D plans to contract with any willing pharmacy and introduce the designation of essential retail pharmacies to provide better classification in rural and underserved areas.
- Enhance transparency and accountability, ensuring PBMs are not limited patient access to available pharmacy options under Medicare Part D.
- Prohibit PBM compensation based on the price of a drug as a condition of entering into a contract with a Medicare Part D plan. Under this legislation, PBM service fees would not be connected to the price of a drug, discounts, rebates, or other fees.
- Create an enforcement mechanism requiring PBMs to pay to the U.S. Department of Health and Human Services Secretary any amount in excess of the designated service fees.
Click here for bill text.
