Pharmacy benefit manager reform provisions that were agreed to in bipartisan, bicameral negotiations but ultimately removed from the slimmed down CR passed on Dec. 20, 2024 would have produced $5 billion in taxpayer savings—see the chart below for details.

Congress must act swiftly and pass these provisions as part of a standalone health care package, or include it in the next government funding packages, budget reconciliation, or any way to get it across the finish line as soon as possible in 2025.

These measures would enhance transparency and eliminate spread pricing in Medicaid managed care programs. These payment reforms would save over $2 billion for taxpayers. It would also require CMS to define and enforce reasonable and relevant contract terms in Medicare Part D which would improve patient access to medications.

Community pharmacies are under-reimbursed on 75 percent of Part D claims and since last June, there has been a net loss of nearly 450 community pharmacies. That is over one a day, affecting tens of thousands of patients. Additionally, PBM practices cause further harm to patients by impeding access to medications through limited formularies and networks, letting insurance companies (not patients and doctors) decide when a drug works for a patient.

PBM reform cannot wait. These agreed-to provisions lower costs for patients, reduce taxpayer costs, and create a fairer playing field for community pharmacies. Congress must get them done now!