Lawmakers say middlemen in the prescription drug pipeline are limiting access to medications and driving up costs.See the story in the video aboveIt’s gotten the attention of both sides of the aisle and President Donald Trump, but reforms are stalled in Congress. Patient advocacy groups representing a range of conditions, from cancer to arthritis to epilepsy, are calling for urgent action to rein in pharmacy benefit managers.So is Jeremy Olimb. His sons are living with cystic fibrosis, a rare genetic disorder with a daunting regimen. “Just seeing young children with handfuls of pills that they have to take in order to survive is a pretty bracing experience for most people,” Olimb said.It’s a harsh reality that Olimb says was made more difficult by treatment barriers his family faced while navigating a new insurance plan earlier this year. For months, he said his sons were forced to take less effective medications, causing discomfort, missed school days, and potentially irreversible damage.”We are just finally getting them back on the drugs that we have spent years knowing are the most effective for them to satisfy the request of the pharmacy benefit managers,” Olimb said. Pharmacy benefit managers, or PBMs, negotiate the terms and conditions for access to prescription drugs for hundreds of millions of Americans. They’re often referred to as “middlemen” because they act as intermediaries between health insurance providers and drug manufacturers. “The things that we all want — affordable, accessible, and quality health care — are all suffering because of PBMs,” said Rep. Buddy Carter, R-Georgia. Part of the problem, according to Carter, is that PBMs have gotten too big. A Federal Trade Commission report published last year notes that, due to decades of mergers, the three largest players now manage nearly 80 percent of all prescriptions filled in the U.S.”Amidst increasing vertical integration and concentration, these powerful middlemen may be profiting by inflating drug costs and squeezing Main Street pharmacies,” the report said. Earlier this year, hundreds of independent community pharmacy advocates from across the country came to Capitol Hill to advocate for reform. “Every day they wait, four pharmacies go out of business, there are four fewer choices for consumers,” said Douglas Hoey, CEO of the National Community Pharmacists Association. Representative Carter is among the lawmakers backing a new bipartisan package that aims to increase transparency and limit certain pricing practices. But PBMs are pushing back.”This legislation would do nothing to lower prescription drug costs for patients or employers,” said the Pharmaceutical Care Management Association, a group that represents PBMs. “To actually deliver savings for Americans, lawmakers should instead focus on the real problem: the exorbitant list prices set by Big Pharma.”David Joyner, the president of CVS Caremark, echoed that message during a congressional hearing last year. “Hampering our ability to negotiate lower drug costs only benefits the pharmaceutical manufacturers,” Joyner said. Indeed, Big Pharma has fueled the campaign against PBMs, pouring millions of dollars into lobbying efforts and advertising.Despite the mounting pressure, the push for PBM reform has faced multiple setbacks in Congress. Provisions were removed from Trump’s “big, beautiful bill” before it passed last month. Last year, similar reforms were scrapped at the last minute to slim down a short-term spending bill. Still, Carter expects PBM reform “will be a priority this Congress,” although his office didn’t provide a timeline for a potential vote. The White House is also getting involved. Trump signed an executive order earlier this year that “reevaluates the role of middlemen” by directing the Secretary of Labor to propose regulations to improve transparency “into the direct and indirect compensation received by pharmacy benefit managers.” Senator Bill Cassidy, R-Louisiana, who chairs the Senate Health, Education, Labor and Pensions Committee, didn’t immediately respond to a request for comment about the path forward for reform, but he addressed the issue in a hearing before lawmakers left town for their August recess. “The president is committed to reevaluating the role of PBMs, and I would argue we as a committee should see this as an opportunity to get this signed into law,” Cassidy said.

WASHINGTON —

Lawmakers say middlemen in the prescription drug pipeline are limiting access to medications and driving up costs.

See the story in the video above

It’s gotten the attention of both sides of the aisle and President Donald Trump, but reforms are stalled in Congress.

Patient advocacy groups representing a range of conditions, from cancer to arthritis to epilepsy, are calling for urgent action to rein in pharmacy benefit managers.

So is Jeremy Olimb. His sons are living with cystic fibrosis, a rare genetic disorder with a daunting regimen.

“Just seeing young children with handfuls of pills that they have to take in order to survive is a pretty bracing experience for most people,” Olimb said.

It’s a harsh reality that Olimb says was made more difficult by treatment barriers his family faced while navigating a new insurance plan earlier this year. For months, he said his sons were forced to take less effective medications, causing discomfort, missed school days, and potentially irreversible damage.

“We are just finally getting them back on the drugs that we have spent years knowing are the most effective for them to satisfy the request of the pharmacy benefit managers,” Olimb said.

Pharmacy benefit managers, or PBMs, negotiate the terms and conditions for access to prescription drugs for hundreds of millions of Americans. They’re often referred to as “middlemen” because they act as intermediaries between health insurance providers and drug manufacturers.

“The things that we all want — affordable, accessible, and quality health care — are all suffering because of PBMs,” said Rep. Buddy Carter, R-Georgia.

Part of the problem, according to Carter, is that PBMs have gotten too big.

A Federal Trade Commission report published last year notes that, due to decades of mergers, the three largest players now manage nearly 80 percent of all prescriptions filled in the U.S.

“Amidst increasing vertical integration and concentration, these powerful middlemen may be profiting by inflating drug costs and squeezing Main Street pharmacies,” the report said.

Earlier this year, hundreds of independent community pharmacy advocates from across the country came to Capitol Hill to advocate for reform.

“Every day they wait, four pharmacies go out of business, there are four fewer choices for consumers,” said Douglas Hoey, CEO of the National Community Pharmacists Association.

Representative Carter is among the lawmakers backing a new bipartisan package that aims to increase transparency and limit certain pricing practices.

But PBMs are pushing back.

“This legislation would do nothing to lower prescription drug costs for patients or employers,” said the Pharmaceutical Care Management Association, a group that represents PBMs. “To actually deliver savings for Americans, lawmakers should instead focus on the real problem: the exorbitant list prices set by Big Pharma.”

David Joyner, the president of CVS Caremark, echoed that message during a congressional hearing last year.

“Hampering our ability to negotiate lower drug costs only benefits the pharmaceutical manufacturers,” Joyner said.

Indeed, Big Pharma has fueled the campaign against PBMs, pouring millions of dollars into lobbying efforts and advertising.

Despite the mounting pressure, the push for PBM reform has faced multiple setbacks in Congress. Provisions were removed from Trump’s “big, beautiful bill” before it passed last month. Last year, similar reforms were scrapped at the last minute to slim down a short-term spending bill.

Still, Carter expects PBM reform “will be a priority this Congress,” although his office didn’t provide a timeline for a potential vote.

The White House is also getting involved. Trump signed an executive order earlier this year that “reevaluates the role of middlemen” by directing the Secretary of Labor to propose regulations to improve transparency “into the direct and indirect compensation received by pharmacy benefit managers.”

Senator Bill Cassidy, R-Louisiana, who chairs the Senate Health, Education, Labor and Pensions Committee, didn’t immediately respond to a request for comment about the path forward for reform, but he addressed the issue in a hearing before lawmakers left town for their August recess.

“The president is committed to reevaluating the role of PBMs, and I would argue we as a committee should see this as an opportunity to get this signed into law,” Cassidy said.