House passes funding bill that includes PBM reform

The House of Representatives yesterday passed the Consolidated Appropriations Act 2026, which provides funding for for the Department of Defense, Labor, Health and Human Services, Education, and Transportation/Housing and Urban Development.

The bill, H.R. 7148, also includes efforts aimed at reforming some pharmacy benefit managers (PBMs) practices, including prohibiting PBM compensation in Medicare Part D from being tied to the drug manufacturer’s list price and requires CMS to track payment trends to pharmacies and pharmacy inclusion in PBM networks.

Under the bill, CMS will receive $188 million to implement an effort to enforce “reasonable and relevant” Medicare Part D contract terms, including information about reimbursement and dispensing fees, and establish an appeals process for pharmacies to dispute terms that do not follow the reasonable and relevant standards.

Additionally, the bill requires PBMs to pass on all rebates and discounts to plan sponsors, and it promotes price transparency by requiring semi-annual reporting on drug spending, rebates, and formulary determinations.

The PBM measures included in the bill have been championed by Earl L. “Buddy” Carter, a Republican from Georgia and pharmacist, who has long tried to pass legislation to address business practices of what he called the “PBM mafia” that “have been stealing hope and health from the American people.”

Last year, Carter was part of hearing by House Committee on Energy and Commerce’s Subcommittee on Health to discuss creating competition in the PBM industry and lower costs for patients. At the hearing, held in January 2025, Carter said patients in Medicare Part D have had to pay a higher copay on a branded medication when generics were available because of how PBM structure rebates and contracts with pharmaceutical companies.

Mark Blum, managing director of the PBM Accountability Project, is urging the Senate to advance these reforms as well. “PBM provisions in this spending package reflect a growing bipartisan consensus that meaningful PBM oversight is essential to lowering drug costs and protecting access to needed medicines,” Blum said in a statement.” The PBM Accountability Project is a coalition of healthcare leaders that advocates for PBM reform, and has been active in achieving policy at the state and federal level.

Pharmacist organizations, including the National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS), have also long supported changes to how pharmacists are paid and PBM practices that they say restrict patient access.

The pharmacist organizations say that over the past year alone, more than 2,200 pharmacies have closed, and since 2018, more than 13% of their pharmacies have closed.

“The PBM reforms included in this package – the first major PBM reform in Medicare Part D to pass in nearly 20 years – are as welcomed as they are long overdue,” Anne Cassity, NCPA’s senior vice president of government affairs, said in a statement.

The Pharmaceutical Care Management Association (PCMA), a trade association for PBMs, said that the measures in the House bill would be costly and will likely result in higher drug costs. PCMA has put the issues of affordability of prescription drugs on pharmaceutical manufacturers. “It will mean fewer ways for employers to drive down drug costs and ultimately lead to higher premiums and out-of-pocket costs for their workers,” resident and CEO David Marin said in a statement.