Pharmacy Groups Urge Congressional Action on PBM Reform as Access Crisis Deepens
December 16, 2025 – A powerful coalition of pharmacy organizations has issued a stark warning to Congressional leaders: the time for Pharmacy Benefit Manager (PBM) reform is now. In a letter delivered friday,the groups detailed a rapidly escalating crisis in pharmacy access,fueled by unchecked PBM practices that inflate drug costs and force self-reliant pharmacies to close at an alarming rate.
The letter, addressed to House Speaker Mike Johnson, House Minority Leader Hakeem Jeffries, Senate Majority Leader John Thune, and Senate Minority Leader Chuck Schumer, represents a unified front from key industry players including the National Association of Chain Drug Stores, the National Community Pharmacists Association, the Food Industry Association, the National Grocers Association, the American Pharmacists Association, and the National Association of Specialty Pharmacy. Their message is clear: continued inaction will have devastating consequences for patients and communities across the nation.
The PBM Problem: A Concentrated Market & Rising Costs
For years, PBMs have operated with increasing scrutiny. These companies act as intermediaries between drug manufacturers, insurance plans, and pharmacies, negotiating drug prices and managing prescription benefits. Though, their increasing vertical integration with insurance companies – the top three PBMs, CVS Caremark, Cigna’s Express Scripts, and unitedhealth Group’s Optum Rx, control roughly 80% of the market – has led to concerns about conflicts of interest and opaque pricing practices.
The core issue lies in how PBMs profit. Practices like “spread pricing,” where PBMs charge payers more for a drug than they reimburse the pharmacy, allowing them to pocket the difference, have come under fire.This lack of clarity directly contributes to higher drug costs for patients and squeezes the margins of pharmacies, particularly independent ones.
A Near Miss & A Worsening Situation
The urgency of the situation is underscored by a recent near-miss. A potential PBM crackdown was included in a federal spending bill in December 2024, only to be removed at the eleventh hour (as reported by MedCity News). Since then, the situation has demonstrably worsened.
“As Congress’ near‑win on PBM reform in December 2024 – another missed opportunity that fell just short of enactment – the devastation of pharmacy access for patients and communities has only worsened,” the letter states. The organizations report a staggering net loss of over six pharmacies per day – an acceleration of the nearly four-per-day closure rate seen in 2023 and 2024. Over 2,200 pharmacies have closed in the last year alone, resulting in a net loss of over 13% of pharmacies since January 2018.
The Call for Concrete reforms
The coalition isn’t simply highlighting the problem; they are advocating for specific, actionable reforms. Their key demands include:
* Medicaid Managed Care Payment Reform & Spread Pricing ban: Addressing unfair payment practices within Medicaid and eliminating the profit-driven practice of spread pricing.
* “Any Willing Pharmacy” Enforcement: Requiring the Centers for Medicare & medicaid Services (CMS) to clearly define and enforce fair contract terms in Medicare Part D, ensuring that all pharmacies willing to meet legitimate requirements can participate in networks.
* decoupling PBM Compensation from List Prices: Prohibiting PBMs from basing their compensation on the list price of drugs in Medicare Part D, incentivizing them to negotiate lower net prices.
* Increased Transparency: Demanding greater transparency in insurer claims and reimbursement practices, providing pharmacies with the data they need to understand and challenge unfair pricing.
“The failure to curb harmful PBM practices is no longer a crisis in the making – it now constitutes a crisis unaddressed,” the letter emphasizes. “Without PBM reform, patients are experiencing inflated drug costs, and many no longer have access to the pharmacy of their choice as pharmacies close and others are pushed out of network.”
Momentum Builds with New Senate Bill
This call to action comes on the heels of a bipartisan effort in the Senate. Senators recently introduced the PBM Price transparency and Accountability act (as reported by MedCity News),which aims to delink PBM compensation from rebates and increase reporting requirements to Medicare and the Department of Health and Human Services (HHS).
the coalition urges Congress to include PBM reform in upcoming legislation, either as part of a larger package or as a standalone measure. ”The consensus is broad,the policy is developed,and the
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