Congress Targets Pharmacy Benefit Managers Amid Drug Pricing Crisis

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 continue to evade accountability.

Instead of confronting those companies, Congress has decided to focus on the entities negotiating against them. Pharmacy benefit managers — PBMs — are now Washington’s latest target, framed as villains in a political narrative that overlooks their critical role.

This approach is emblematic of easy politics: few voters understand exactly what PBMs do, and labeling them as “middlemen” provides a convenient scapegoat. However, dismantling PBMs won’t lower costs—it will likely drive them higher.

PBMs aren’t flawless, but they serve an essential function. They leverage their bargaining power to counteract drugmakers who treat life-saving medications like luxury goods. By negotiating rebates and discounts, they reduce expenses for health plans, employers, and families. When integrated with insurers and pharmacies, PBMs streamline care, eliminate inefficiencies, and guide patients toward affordable treatments.

This isn’t greed—it’s a system of checks and balances working in consumers’ favor.

So why the sudden push to weaken PBMs? Big Pharma has long mastered the art of deflecting blame, now pointing fingers at the only entity challenging its pricing dominance. Many lawmakers—across both parties—are complicit in this narrative.

Proposals from Congress would severely limit PBMs’ ability to negotiate, banning key contracting tools, capping revenues, and eroding their capacity to hold drugmakers accountable. If Washington truly aims to make prescriptions more affordable, it must address the root cause: the exorbitant list prices set by pharmaceutical companies. These prices dictate every cost downstream.

No amount of interference with negotiators will resolve a crisis rooted in unchecked monopoly pricing. The reality is stark: drug prices are high because manufacturers set them that way. PBMs act as a counterweight, not the source of the problem.

Undermining the mechanisms that currently work won’t ease patients’ burdens—it will increase their financial strain. If lawmakers are serious about reducing costs, they should stop heeding the demands of price-setting corporations and instead protect those bearing the burden.