U.S. Reps. Buddy Carter (R-GA) and Greg Murphy (R-NC) on July 10 joined a bipartisan contingent of 10 congressional members to propose a bill that would prohibit pharmacy benefit managers (PBMs) from driving up the costs of drugs for Medicare beneficiaries.
Rep. Carter sponsored the Pharmacy Benefit Manager (PBM) Reform Act of 2025, H.R. 4317, alongside almost a dozen original cosponsors, including Rep. Murphy and U.S. Rep. Debbie Dingell (D-MI), to assure pharmacy access and choice for Medicare beneficiaries.
“It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades,” Rep. Carter said. “As a pharmacist, I’ve seen how PBMs abuse patients firsthand, and believe that the cure to this infectious disease is transparency, competition, and accountability, which is exactly what our bipartisan package provides.”
If enacted, H.R. 4317 would ban “spread pricing” in Medicaid and move to a transparent system that ensures pharmacies are fairly and adequately reimbursed for serving Medicaid beneficiaries.
The bill also would establish new requirements for PBMs under Medicare Part D, including a policy to delink PBM compensation from the cost of medications and increase transparency, according to a summary of the 97-page bill provided by the lawmakers.
“Unaffordable health care, unclear pricing practices, and a burdensome system that is difficult to navigate has created life-threatening barriers to care for Americans,” said Rep. Murphy. “At the heart of this problem are PBMs, middlemen who withhold money from independent pharmacies, obscure drug costs, and make out like bandits, all at the expense of patients.”
The congressman also pointed out that small business owners, physicians, and patients have described for years “the damage greedy PBMs have inflicted. I am proud to support this bipartisan legislation to put an end to the extortion and lower drug costs through increased transparency and competition,” he said.
Additionally, H.R. 4317 would require the Centers for Medicare and Medicaid Services (CMS) to define and enforce “reasonable and relevant” contract terms in Medicare Part D pharmacy contracts and enforce oversight on reported violations, among other provisions, the summary says.
“I hear from too many Michiganders, especially seniors, who can’t conveniently access the prescriptions they need, due to exploitative PBM practices complicating access to their local pharmacies,” Rep. Dingell added. “Their harmful, aggressive tactics are only getting worse, and we must take action now to protect pharmacies and lower patient costs.”