Why it Matters

Pharmacy benefit managers (the largely invisible intermediaries that negotiate drug prices between manufacturers, insurers, and pharmacies) are facing a formal congressional reckoning. The House Subcommittee on Health, Employment, Labor, and Pensions has scheduled a PBM hearing for Wednesday, April 22, titled "Profits Over Patients: The PBM Business Model Under Scrutiny." For millions of Americans whose drug costs flow through PBM-controlled networks, what gets said and what gets introduced in that hearing room could shape whether reform legislation finally moves.

The three largest PBMs (CVS Caremark, OptumRx, and Express Scripts) collectively process the majority of U.S. prescription drug claims. Critics argue they extract value at every point in the supply chain through spread pricing, opaque rebate arrangements, and preferential treatment of affiliated pharmacies. The industry disputes that characterization. Congress has been circling this fight for years. This hearing suggests the 119th Congress intends to press it.

A Year of Lobbying Before the Pharmacy Hearing 2026

The financial stakes are visible in the lobbying disclosures filed in the year leading up to the congressional PBM hearing. Major players on all sides of the debate have been active.

CVS Health, which operates the Caremark PBM, reported $105,000 per quarter in lobbying expenditures across three quarterly filings (totaling $315,000) on "issues relating to legislation and regulations affecting Pharmacy Benefit Managers." UnitedHealth Group, whose OptumRx subsidiary is one of the largest PBMs in the country, reported $90,000 per quarter across multiple filings, specifically referencing Senate bills S.1339 and S.2973 as legislative targets.

The Pharmaceutical Care Management Association (PCMA), the trade group representing PBMs directly, filed $60,000 per quarter across three reports, tracking a wide portfolio of reform bills including H.R.4317, H.R.5378, S.1339, and S.2973. On the other side, PhRMA, whose manufacturer members have long clashed with PBMs over rebate structures, spent $240,000 across four quarterly reports lobbying on "Pharmacy Benefit Manager issues and reform," including HR 830, the SAFE Act.

Independent pharmacies, which have argued for years that PBM reimbursement practices are driving them out of business, were also active. The Independent Pharmacy Cooperative filed multiple reports totaling over $130,000, focused on "PBM transparency and reform" and referencing S.526, the Pharmacy Benefit Manager Transparency Act of 2025. Johnson & Johnson, Merck, Navitus Health Solutions, Transparency-Rx Corp., and Vizient Inc. also filed PBM-specific disclosures during the period.

Across the major identified organizations alone, PBM-related lobbying expenditures exceeded $1.5 million in the year before the pharmacy hearing in 2026.

The Legislation in Play

The PBM committee hearing arrives against a backdrop of active pharmacy legislation across both chambers.

S.526, the Pharmacy Benefit Manager Transparency Act of 2025, introduced by Sen. Chuck Grassley (R-IA) with bipartisan co-sponsorship, would prohibit PBMs from charging health plans more than they reimburse pharmacies (a practice critics call "spread pricing") and ban arbitrary clawbacks of pharmacy payments. It remains in the Senate Commerce Committee.

H.R.4317, the PBM Reform Act of 2025, introduced by Rep. Buddy Carter (R-GA), was referred to the Education and Workforce Committee (the same panel holding next week's hearing) along with Energy and Commerce and Ways and Means. The bill would require PBMs to open pharmacy networks to qualified providers by 2029 and restrict PBM income to legitimate service fees only.

S.3345, the PBM Price Transparency and Accountability Act, introduced by Sen. Mike Crapo (R-ID) in December 2025, targets spread pricing specifically in Medicaid and Medicare, requiring the federal government to set reimbursement standards based on actual drug costs.

S.927, the Protecting Pharmacies in Medicaid Act, introduced by Sen. Peter Welch (D-VT), would fund CMS surveys of retail and non-retail pharmacy pricing under Medicaid and direct the HHS Inspector General to study PBM spread pricing practices. None of these bills have advanced to floor consideration in either chamber.

What Committee Members Have Been Saying

In the weeks before the pharmacy benefit manager hearing, several subcommittee members signaled where their priorities lie.

Rep. Joe Courtney (D-CT) wrote publicly about what he called a "cost-of-living crisis" driven by the "relentless increase in the cost of life-saving prescription drugs," advocating for the Lower Drug Costs for American Families Act. Rep. Summer Lee (D-PA) highlighted that "130,000 Pennsylvanians dropped their healthcare coverage because costs are too high," framing the issue as a structural failure of the current system. Rep. Donald Norcross (D-NJ) addressed drug pricing and "higher prices" in recent public communications.

On the Republican side, subcommittee Chair Rick Allen (R-GA) will preside. The hearing title itself, "Profits Over Patients," suggests the majority intends to put PBM business practices on the defensive, not simply examine them academically.

The Bottom Line

The Subcommittee on Health, Employment, Labor, and Pensions of the House Education and Workforce Committee will convene with Rep. Rick Allen, who chairs the subcommittee; Rep. Mark DeSaulnier (D-CA) serves as Ranking Member. The hearing notice has been published, but no witnesses have been formally announced.

The congressional PBM hearing lands as the broader Republican budget reconciliation effort puts pressure on Medicaid spending. The program has drawn particular scrutiny from both parties. Whether the hearing produces legislative momentum or remains an investigative exercise will depend heavily on which witnesses appear and whether the committee's bipartisan frustration with PBMs translates into a shared reform vehicle.

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