"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, promptingemployer groups including the Purchaser Business Group on Health (PBGH) and the ERISA Industry Committee to cheer its passage."
"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, Dresser 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."
Congress enacted the Consolidated Appropriations Act of 2026 to impose new controls on Pharmacy Benefit Managers (PBMs) and increase accountability. Employer groups including PBGH and the ERISA Industry Committee welcomed the reforms as lowering costs and delivering unprecedented transparency into pharmacy benefit plans. A key provision delinks PBM compensation from drug prices only in Medicare Part D. Spread pricing will be prohibited in Medicare Part D, preventing PBMs from keeping the difference between plan charges and pharmacy payments, with changes taking effect in 2028. Commercial employer plans did not secure a spread-pricing ban or PBM fiduciary status. The law still promises meaningful change in PBM commercial operations.
Read at MedCity News
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