Published in MedCityNews
For years, Congress has signaled that it wants to crack down on Pharmacy Benefit Managers, the middle men that have come under fire for their vertical integration with insurers and their role in spiking drug costs.
This week, it finally happened via the Consolidated Appropriations Act of 2026, prompting employer groups including the Purchaser Business Group on Health (PBGH) and the ERISA Industry Committee to cheer its passage.
But the reality is more complicated. While it is true that there were major gains made by employers, one of the most significant parts of the law — the delinking of PBM compensation from the price of a drug in Medicare Part D — eluded employer groups. This is a provision in the new law that only applies to Medicare Part D, according to Jesse Dresser, a partner in Frier Levitt’s Life Sciences Department.
In Medicare Part D, spread pricing was also prohibited as PBMs will no longer be able to derive any revenue tied to the cost of the drug, Jesse stated. Spread pricing occurs when a PBM charges a health plan more for a drug than it pays the pharmacy and keeps the difference as profit. The changes will take effect in 2028.
Read the full article here: https://medcitynews.com/2026/02/employers-pbm-reform/
