Every day, people walk into their local pharmacy and face a price they can’t afford for a drug they can’t live without.
Families are being forced to choose between paying for lifesaving prescriptions and covering basic necessities. At the same time, the community pharmacists who provide these critical medications are struggling to keep their doors open.
You deserve to know why this is happening and who is benefiting from it.
The answer: We are paying the price for PBM greed.
Since 2021, the House Committee on Oversight and Government Reform has investigated pharmacy benefit managers, commonly known as PBMs. PBMs operate as middlemen in the prescription drug market, negotiating with drug manufacturers, health insurers, local pharmacies, and federal health programs.
PBMs claim they lower prescription drug costs. But the evidence tells a much different story.
Our investigation, which included more than 140,000 documents and communications, exposed how PBMs use their position as middlemen to benefit themselves at the expense of patients and community pharmacists.
The three largest PBMs now control 80% of the market. PBMs retain rebates and fees that should be used to lower costs. PBMs steer patients away from independent pharmacies and toward pharmacies they own. PBMs use rigged reimbursement schemes that force community pharmacies to provide medications at a loss. PBMs even favor more expensive medications when cheaper and equally effective drugs are available.
I have met with pharmacists throughout Kentucky who are pillars of their communities. They know their patients by name, answer questions about medications, and often serve as one of the most accessible healthcare providers in rural areas. Yet many are being squeezed out of business by predatory PBM practices.
It’s clear this system is not working for the public. But it is working for the powerful PBMs who profit from it.
Congress has talked about these problems for long enough. It’s time to take on the middlemen.
That is why I joined Reps. Jake Auchincloss (D-MA) and Diana Harshbarger (R-TN) to introduce the bipartisan Pharmacists Fight Back Act. Today, the oversight committee will take an important step toward holding PBMs accountable by passing this legislation.
The Pharmacists Fight Back Act replaces rigged PBM payment schemes with a transparent system based on the actual cost of medications, plus a fair fee for pharmacists who dispense them. This prevents PBMs from manipulating prices and forcing independent pharmacies to fill prescriptions at a loss.
The legislation also protects patients’ freedom to choose where they fill their prescriptions. PBMs should not be allowed to restrict pharmacy networks or steer people toward pharmacies they own simply to line their own pockets.
Finally, the legislation strengthens oversight and imposes serious penalties on PBMs that break the law. Transparency without enforcement is meaningless. This bill has the teeth needed to hold bad actors accountable.
These reforms will ultimately help lower patients’ out-of-pocket prescription drug costs, protect access to lifesaving medications, support community pharmacies, and safeguard your taxpayer dollars.
This is not a Republican or Democrat issue. People across the country are paying too much for prescription drugs. The Pharmacists Fight Back Act has bipartisan support because putting patients ahead of powerful PBMs is common sense.
As chairman of the oversight committee, I made it a priority to expose the PBM industry’s harmful practices. We followed the facts, brought PBM executives before Congress, and showed the public how these middlemen have contributed to higher costs, fewer choices, and worse care.
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Now we are turning those findings into action. This legislation will soon be one step closer to the president’s desk.
The PBM industry is on notice: Its era of taking advantage of patients, taxpayers, and community pharmacists is coming to an end.
James Comer is a member of the U.S. House of Representatives, serving Kentucky’s 1st Congressional District.