E&C Health Panel Determined To Rein In Remaining PBM Business Tactics

Why It Matters

Continued congressional scrutiny could force industry‑wide changes to PBM contracts, potentially lowering prescription drug prices and increasing transparency for payers and consumers.

Key Takeaways

• Subcommittee demands PBM adherence to Express Scripts settlement
• Chair Carter targets traditional PBM lobby leadership
• FTC settlement focuses on pricing transparency
• Regulatory pressure may reshape rebate structures

Pulse Analysis

The House Energy & Commerce health subcommittee’s recent questioning of PBM lobby leadership reflects a broader legislative push to dismantle opaque pricing mechanisms that have long plagued the pharmaceutical supply chain. By referencing Cigna’s Express Scripts settlement with the FTC, lawmakers are signaling that the voluntary commitments made by one major PBM could become a de‑facto benchmark for the entire industry. This approach leverages existing regulatory outcomes to accelerate reform without waiting for protracted rulemaking processes.

Pharmacy benefit managers sit at the nexus of insurers, drug manufacturers, and patients, wielding significant power over formulary design, rebate negotiations, and patient cost‑sharing. The FTC settlement requires Express Scripts to disclose rebate calculations and limit certain spread‑pricing practices, measures that could translate into lower out‑of‑pocket costs if adopted broadly. As Congress pressures other PBMs to follow suit, insurers may renegotiate contracts, potentially shifting more savings to consumers and reducing the overall drug spend burden on Medicare and Medicaid programs.

Looking ahead, the subcommittee’s stance suggests that future legislative proposals may embed settlement‑derived standards into law, creating a more uniform regulatory framework for PBMs. Stakeholders—including drug manufacturers, health plans, and patient advocacy groups—must monitor these developments closely, as they could reshape rebate flows, impact drug pricing strategies, and alter the competitive dynamics among PBMs. Companies that proactively align with the emerging transparency expectations may gain a strategic advantage in a market increasingly focused on cost containment and consumer trust.