PBM Act

Key Points

• This bill, called the Patients Before Monopolies Act, would make it illegal for the same company to own both a pharmacy benefit manager (PBM) and a pharmacy. PBMs are the middlemen who decide which drugs your insurance covers and how much you pay.
• Large health care companies that currently own both insurance plans and pharmacies would have one year to sell off their pharmacy businesses. The bill also bans insurance companies from owning pharmacies, targeting the biggest conglomerates that control over 90% of prescriptions.
• Supporters point to the closure of more than 7,000 pharmacies in recent years and argue that when one company owns every step of the drug supply chain, it can raise prices and squeeze out smaller competitors. Separating these businesses aims to lower drug costs and help independent pharmacies survive.
• If companies miss divestment deadlines, 10% of their monthly profits go into escrow and could be forfeited. Regular people, state attorneys general, and federal agencies can all sue violators, with courts allowed to award triple damages and require companies to give back revenue earned from illegal pharmacy operations.
• The bill has bipartisan support with six co-sponsors from both parties. It was introduced by Rep. Harshbarger and referred to the House Judiciary Committee, signaling that Congress views this as an antitrust and competition issue rather than purely a healthcare matter.