Why It Matters

Congress is moving aggressively to overhaul how pharmacy benefit managers operate, and PCMA faces an existential threat. Lawmakers are united across party lines to ban or fundamentally reshape PBM compensation models, transparency practices, and network participation rules—all directly threatening the industry’s current profit streams. Over 7,000 pharmacies have closed nationwide since 2022, creating visible political pressure that makes reform politically irresistible.

The FTC is actively suing the three largest PBMs for inflating insulin prices, while Congress has introduced legislation targeting spread pricing, price-linked compensation, and mandatory network access.

By the Numbers

The Pharmaceutical Care Management Association (PCMA) has filed 315 disclosures and spent approximately $107.9 million over two decades. For the last quarter of 2025, PCMA retained Ryan Costello Strategies LLC for $50,000, continuing a relationship that began in August 2023.

Ryan Costello is a former Republican congressman from Pennsylvania who served on the House Energy and Commerce Committee—the committee now drafting much of the PBM reform legislation PCMA opposes. His firm has generated approximately $4.5 million in lobbying income since 2020 serving clients including Google, T-Mobile, and Ford Motor.

The Agenda

PCMA is lobbying against government mandates on pharmacy benefit managers and monitoring congressional activity surrounding PBM reform. Ryan Costello Strategies LLC is advocating against government intrusion into the commercial insurance marketplace and expressing concerns about Medicaid Part D provisions. The firm is monitoring relevant committee hearings on the DRUG Act (HR 2214), which Costello has previously lobbied against for PCMA.

Broader Context

Congress is advancing unprecedented, bipartisan legislation to fundamentally reshape how pharmacy benefit managers operate. The PBM Reform Act of 2025, the Pharmacy Benefit Manager Transparency Act of 2025, and other bills aim to ban spread pricing and delink PBM compensation from drug prices.

Federal enforcement has intensified. The FTC sued the three largest PBMs in September 2024, finding that insulin markups reach $300-$700 despite $2 production costs. The agency documented how PBMs reaped $7.3 billion from marking up specialty generic drugs.

State-level reform is accelerating. California banned spread pricing, and by mid-2025, all 50 states were considering PBM reform legislation.

Between The Lines

Multiple bills targeting PBMs are advancing through Congress with bipartisan support:

Key lawmakers from both parties are driving reform. Senator Chuck Grassley (R-IA) has highlighted that three major PBMs control 80% of the market. Representative Buddy Carter (R-GA), a pharmacist, has led comprehensive bipartisan reform efforts.

Competitive Landscape

PCMA faces well-organized opposition advancing PBM reform legislation. American Pharmacy Cooperative Inc., representing independent pharmacies, has lobbied for multiple reform bills. Notably, Navitus Health Solutions LLC—itself a PBM—has lobbied on transparency reform, suggesting industry fractures on reform strategy.

A broad coalition of over 100 organizations representing millions of employers and patients has called for comprehensive PBM reform. Over 30 PBM-related bills passed across 20 states in 2024, with state legislatures introducing more than 1,250 PBM-related bills by spring 2025.

The Bottom Line

PCMA is ramping up defensive lobbying amid intense bipartisan pressure to overhaul PBM practices. The organization’s $50,000 quarterly retainer of Ryan Costello Strategies LLC signals determination to fend off legislation constraining its members’ business models. Congress is moving swiftly on multiple reform bills with overwhelming bipartisan support, citing pharmacy closures and inflated drug costs as justification. PCMA’s engagement with external lobbying firms reflects the existential challenge the PBM industry faces as momentum for change solidifies across federal and state levels.

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