Senators Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.), alongside Representatives Diana Harshbarger (R-Tenn.) and Jake Auchincloss (D-Mass.), introduced the Patients Before Monopolies (PBM) Act, a bipartisan bill aimed at addressing conflicts of interest in the pharmacy benefit manager (PBM) industry.
The proposed legislation seeks to dismantle the vertical integration of PBMs, pharmacies, and insurance companies, which lawmakers argue drive up drug costs and harm independent pharmacies.
Over the past decade, PBMs — the middlemen negotiating between pharmacies and insurers — have consolidated into powerful health care conglomerates. These corporations now control PBMs, the pharmacies they reimburse, and even the insurance plans that set terms for coverage. Lawmakers and advocates say this concentration of power enables self-dealing that inflates drug prices, limits patient choices, and squeezes independent pharmacies out of business.
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“The insurance monopolies are ruining American health care,” said Senator Hawley. “Patients and independent pharmacies are paying the price. This legislation will stop the insurance companies and PBMs from gobbling up even more of American health care and charging American families more for less.”
Key Provisions of the PBM Act
The Patients Before Monopolies Act proposes the following measures:
- Prohibiting PBMs and insurers from owning or operating pharmacy businesses.
- Requiring companies in violation to divest their pharmacy businesses within three years.
- Empowering federal agencies like the FTC, DOJ, and state attorneys general to enforce divestitures and recover ill-gotten revenue.
- Directing the FTC to distribute recovered funds to affected consumers and communities.
- Mandating federal oversight of all divestitures and subsequent acquisitions to protect competition and public interest.
The legislation has drawn bipartisan support, with lawmakers from both sides of the aisle emphasizing its importance. Senator Warren called out PBMs for their anti-competitive behavior: “PBMs have manipulated the market to enrich themselves — hiking up drug costs, cheating employers, and driving small pharmacies out of business. This bipartisan bill will untangle these conflicts of interest.”
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Representative Harshbarger, a lifelong pharmacist, spoke from personal experience: “Unchecked PBM consolidation and vertical integration have allowed these middlemen to self-deal, manipulate the system, and hurt independent pharmacies. This bipartisan act ensures fair competition, protects consumers, and reins in these monopolistic practices.”
The PBM Act has received endorsements from a wide range of organizations, including the American Economic Liberties Project, National Community Pharmacists Association, and Patients Rising. Advocates argue that eliminating conflicts of interest in the PBM model is critical to lowering drug prices, protecting patient access, and ensuring the viability of independent pharmacies.
Morgan Harper, Policy Director at the American Economic Liberties Project, stated: “This legislation addresses the root cause of higher drug costs and reduced patient access — consolidated market power within PBMs. We applaud this bipartisan effort to restore competition and fairness.”
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The introduction of the Patients Before Monopolies Act adds to a growing push in Congress to tackle anti-competitive practices in the health care industry. With mounting public frustration over rising drug costs, lawmakers hope the legislation will gain momentum.
As Senator Warren emphasized: “It’s time to put patients before monopolies, and this bill is a critical step toward fixing our broken health care system.”
Advocates and lawmakers are now urging Congress to move quickly on the legislation, which they argue will benefit consumers, independent pharmacies, and the broader health care system.
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