Coalition for PBM Reform Participates in Congressional Forum on the Role of Pharmacy Benefit Managers

Washington, D.C. (November 17, 2021) — The Coalition for PBM Reform was strongly represented by three of its members at this morning’s Congressional forum about the role of Pharmacy Benefit Managers (PBMs) and their impact on prescription drug prices, hosted by Representative James Comer, Ranking Member of the House Committee on Oversight and Reform. The forum aimed to build greater awareness about the need for PBM reform among the public and within Congress, and the Coalition for PBM Reform will continue to work on bipartisan legislation to create greater transparency in PBM practices.

Today’s current system allows PBMs to engage in anticompetitive practices at the detriment of consumers, patients, providers, and employers. Therefore, we strongly support reforms that would bring increased transparency, oversight, and accountability of PBMs to help control drug costs, provide greater protections for patients regarding their prescription drug benefits programs, give providers greater control of prescribing medicines for patients, and stabilize the operating environment for pharmacies of all kinds. The Coalition represents patients, healthcare providers, pharmacies, and business organizations.

Below are excerpts from the remarks made by the Coalition’s industry experts:

“2021 has seen increased scrutiny of PBMs and legislation to rein in the corporate giants’ influence,” said Ted Okon, Executive Director of the Community Oncology Alliance and member of the Coalition for PBM Reform. “Several states, including Texas, Georgia, and Tennessee, have passed laws to increase transparency in the PBM industry. The laws also prohibit procedures like direct and indirect remuneration (DIR) fees and establish fair audit systems for local pharmacies. Now, federal legislators are taking notice and considering action at the national level.”

“Formularies should be constructed on efficacy, safety, and lowest list price, which removes kickbacks from the picture and creates a race to the bottom of pricing, as opposed to our present system which fosters a race to the top,” said Dr. Madelaine Feldman, President of the Coalition of State Rheumatology Organizations and member of the Coalition for PBM Reform. “Reform would bring us closer to a system that centers the patient as the ultimate consumer to be served.”

When asked by Ranking Member James Comer why his pharmacy declined to sign a “take-it-or-leave-it” contract with PBMs, Dr. Jonathan Grider, owner of Lake Cumberland Pharmacy and member of the National Community Pharmacists Association, a partner of the Coalition for PBM Reform explained, “If you don’t sign, they’ll just steer their patients to their own pharmacy or to mail order. The PBMs don’t care. They set the rules, they set the terms, they set the reimbursements.”

Members of the panel also highlighted how PBMs and health insurers were using vertical integration to heighten profits by controlling each aspect of drug purchasing and distribution. There were also specific examples of how patients are being funneled to more expensive and therefore more profitable drugs by the PBMs.

You can watch the forum here.


The Coalition for PBM Reform amplifies the voices of patients, health care providers, employers, and payers regarding the need for policies that address the PBMs threatening effective and affordable access to local health care in our country.