The changes apply to pharmacy benefit managers—the middlemen in the pharmacy business—but experts are unsure how much drug prices will come down.
Congress has passed a series of reforms intended to lower prescription drug prices, although some industry analysts say the impact may be less than expected.
The reforms affect the operation of pharmacy benefit managers, which are companies that negotiate prescription drug prices for health insurers and employer-sponsored health plans.
Independent pharmacists and some members of Congress had long sought these reforms but were unable to get them through both houses of Congress.
The changes were finally passed as part of the Consolidated Appropriations Act of 2026, which was signed by President Donald Trump on Feb. 3.
“This was a win for the patient. This was a win for all Americans. It was a win for health care,” Rep. Buddy Carter (R-Ga.), a pharmacist and advocate for reform, told reporters on Feb. 4.
Brendan Buck, chief communications officer for Pharmaceutical Care Management Association, the trade group for pharmacy benefit managers, called it a win for pharmaceutical companies.
“It is the culmination of a years-long effort by drugmakers to convince Congress that [pharmaceutical benefit managers] are the problem with high drug costs,” Buck said in a Feb. 4 statement, predicting that the changes would increase prices.
Here’s what you need to know about pharmaceutical benefit managers and the reforms affecting drug prices.
Pricing Reforms
Drugmakers and independent pharmacists have long criticized what they call opaque pricing strategies used by pharmacy benefit managers.
Sen. Marsha Blackburn (R-Tenn.) said pharmacy benefit managers should be removed from the prescription drug supply chain. “They do not add value for the patient,” Blackburn said on Feb. 4. She said the intermediary “increases the cost and limits the options for the patients.”
Others dispute the characterization, saying that pharmacy benefit managers are effective in reducing consumer costs.
Rep. Eric Burlison (R-Mo.) said pharmacy benefit managers help consumers leverage their collective buying power. “If you join Sam’s Club or Costco, you’re joining with others, and you’re able to bulk purchase and drive down costs,” Burlison said in a Jan. 26 forum with the Competitive Enterprise Institute.
Pharmacy benefit managers have made money in two ways. One is by negotiating discounts or rebates with drugmakers on behalf of their clients and retaining a portion of that savings.
“We don’t know where the rebates go,” Rep. Diana Harshbarger (R-Tenn.), who is a pharmacist, told reporters on Feb. 4.
The second practice is spread pricing, in which the pharmacy benefit manager will charge the insurance company or other party a higher price for the drug than it pays the pharmacy, keeping the “spread” for itself.
Under the new law, pharmacy benefit managers contracting with Medicare Part D plans and employer group health plans must pass on 100 percent of the rebates, fees, and other remuneration they receive to their clients, insurance companies, or other payers.
Pharmacy benefit managers will be paid through flat-rate service fees rather than a percentage of a drug’s value, eliminating an incentive to profit from higher drug prices, Harshbarger said.
