Congress’s Attack on Pharmacy Benefit Managers Threatens Prescription Affordability

By Charlie Kolean

Every time Americans fill a prescription, they’re reminded that the system isn’t built for them. Prices keep climbing, politicians keep posturing, and the same companies responsible for setting sky-high drug costs keep getting a free pass. Instead of confronting those companies, Congress has decided to go after the people negotiating against them. Pharmacy benefit managers — PBMs — are suddenly everyone’s favorite villain in Washington, D.C.

It’s easy politics: few voters know exactly what PBMs do, and “middlemen” make easy scapegoats. But tearing them down won’t make medicine cheaper. It’ll do the opposite. PBMs aren’t perfect, but they play an essential role. They use bargaining power to push back on drugmakers that treat life-saving medications like luxury goods. They negotiate rebates and discounts that lower costs for health plans, employers, and families. And when PBMs are integrated with insurers and pharmacies, they can coordinate care more efficiently, cut red tape, and steer patients toward affordable treatments.

That’s not greed — it’s leverage working for consumers. So why the sudden campaign to tie their hands? Big Pharma has spent decades perfecting the art of blame-shifting. Now, it’s pointing fingers at the only part of the supply chain that challenges its pricing power. And too many lawmakers — Republican and Democrat alike — are swallowing the story whole.

The proposals coming out of Congress would cripple PBMs’ ability to negotiate. They’d ban common contracting tools, cap earnings, and dismantle the very leverage that holds drugmakers accountable. If Washington wants to make prescriptions more affordable, it needs to start at the source—the list price set by pharmaceutical companies. Those are the numbers that drive every cost downstream. No amount of tinkering with the negotiators will fix a problem rooted in unchecked monopoly pricing.

The truth is simple: drug prices are high because drugmakers set them high. PBMs are the counterweight, not the cause. Breaking the few mechanisms that still work won’t bring relief to patients — it’ll bring higher bills. If lawmakers are serious about lowering costs, they need to stop taking cues from the companies writing the prices and start defending the people paying them.