Washington, D.C. — A bipartisan group of lawmakers, led by Rep. Earl L. “Buddy” Carter (R-GA), has introduced the PBM Reform Act (H.R. 4317) in the House of Representatives. The bill includes all of the National Community Pharmacists Association’s (NCPA) legislative priorities that were originally part of the December 2024 Continuing Resolution package.
The legislation follows a ruling by the Senate parliamentarian that blocked PBM reform from being included in the June budget reconciliation process.
Rep. Carter, a pharmacist by trade, emphasized the urgency of reform, saying, “It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades. The cure is transparency, competition, and accountability—exactly what our bipartisan package provides.”
NCPA CEO Douglas Hoey expressed strong support for the bill, stating, “As PBMs continue manipulating drug pricing, extinguishing their competition, and raking in massive profits, patients and pharmacies are suffering. We need systemic change like what’s in the PBM Reform Act, and we need it now.”
Key provisions in the PBM Reform Act (H.R. 4317):
- Ban spread pricing in Medicaid, transitioning to a transparent reimbursement model that ensures fair payment to pharmacies.
- Reform Medicare Part D by:
- Delinking PBM compensation from drug prices.
- Enhancing transparency in PBM operations.
- Increase transparency for employers and patients through semi-annual reporting on:
- Drug costs
- Manufacturer rebates
- Formulary determinations
- Strengthen Medicare Part D pharmacy contract oversight by:
- Requiring CMS to define “reasonable and relevant” contract terms.
- Mandating the enforcement of violations.
NCPA pledged to advocate vigorously for the bill’s passage, calling it a necessary step toward fairer drug pricing and better care access.
The PBM Reform Act was introduced by Reps. Buddy Carter (R-Ga.), Debbie Dingell (D-Mich.), Greg Murphy (R-N.C.), Deborah Ross (D-N.C.), Jodey Arrington (R-Texas), Diana Harshbarger (R-Tenn.), Vicente Gonzalez (D-Texas), Rick Allen (R-Ga.), Raja Krishnamoorthi (D-Ill.), John Rose (R-Tenn.), Derek Tran (D-Calif.), and Nicole Malliotakis (R-N.Y.).
AAP will continue to update you on the progress of this bill as it works its way through the legislature.