More Than 100 Organizations Urge Congress to Pass PBM Reform Before Year’s End

A coalition of employers, patient advocacy groups and health organizations representing millions of Americans called on Congress to act swiftly to pass comprehensive reforms to increase transparency and accountability among pharmacy benefit managers before the close of 2025. 

In a joint letter sent to members of Congress on Tuesday, more than 100 organizations—including the ERISA Industry Committee, American Diabetes Association, National Association of Manufacturers, Blue Shield of California and Arthritis Foundation—urged lawmakers to revisit and pass the policies included in a December 2024 bipartisan health care package, which ultimately was not passed. 

The package was agreed upon by both chambers to be included in a 2024 year-end continuing resolution. However, the reforms ultimately failed to make the final version of the bill.  

The reforms would require full transparency of PBM business arrangements and financial incentives, ban spread pricing, ensure 100% pass-through of rebates and discounts to plan sponsors and patients, and de-link PBM compensation from drug prices. 

These steps would help restore fairness and competition to the prescription drug market while ensuring that savings benefit patients rather than middlemen, according to the letter. 

“Every day without action is a day in which Americans are forced to make impossible choices—between their health and their financial stability,” the letter stated. 

Despite bipartisan support, these provisions were eliminated from 2024 legislation due to concerns about their potential influence on pharmaceutical prices in the commercial market and opposition from Republicans.  

As the letter stated, however, criticism of PBMs has continued.  

The group letter emphasized that PBMs—the intermediaries between drug manufacturers, insurers and pharmacies—have outsized influence over which medications patients can access and at what cost. According to the group, three PBMs currently process nearly 80% of all prescription drug claims in the U.S., giving them “immense market power” and contributing to higher costs and restricted access for patients. 

The groups argued that PBM practices have created a “skewed marketplace” that drives up drug prices, limits patient choice and hinders employers’ ability to negotiate fair contracts. Patients, particularly those managing chronic or serious conditions, face “delays, denials, and unaffordable prices for life-saving medications,” the letter stated, despite most employers covering most of their workers’ health care costs. 

Issues related to drug pricing and cost transparency have been the subject of litigation, state legislation and the Department of Labor’s regulatory agenda in 2025. In addition, provisions of the Consolidated Appropriations Act of 2021 and the Employee Retirement Income Security Act gave plan sponsors fiduciary responsibility over health care benefits, including pharmacy benefits and other health plan oversight, similar to their responsibility in retirement plans.