Pharmacy Benefit Managers Escape Regulation Despite Intense Lobbying Efforts

The Pharmaceutical Care Management Association (PCMA), the largest trade group representing pharmacy benefit managers (PBMs), successfully lobbied Congress not to take any action this spring to regulate their operations. In the first three months of 2023, PCMA increased its spending on lobbying by 71%, spending $4.8 million. Despite efforts by members of Congress to increase transparency and reform PBM practices, the odds were stacked against them.

The House passed a package aimed at increasing transparency in PBM operations, while two Senate committees also passed significant reforms that would impact how PBMs operate in Medicaid, Medicare, and the commercial insurance market. However, these reforms were included in a large government spending bill, which allowed members of Congress to avoid voting on individual issues related to PBM regulation.

Public health programs are typically noncontroversial and have broad support among lawmakers, but they were still impacted by the lack of action on PBM regulation this spring. Without oversight from Congress, PBMs continue to operate as middlemen between drugmakers and health insurers with little accountability or transparency in their practices.