Our Take
A bill with real bipartisan traction but no clear path past industry lobbying—PBMs control pharmacy networks and will argue divestiture weakens their negotiating power, not strengthens it.
Why it matters
Benefits advisors and employers face real pressure on drug costs. Congress is signaling antitrust appetite, but PBMs control 98% of prescriptions in the US, making any structural change a years-long fight.
Do this week
Benefits leaders: document your pharmacy network costs and PBM rebate structures now so you can model the impact of forced divestiture on your plan design before 2026.
Congress reintroduces pharmacy ownership breakup bill with bipartisan backing
Sens. Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.) have reintroduced the Patients Before Monopolies Act in the 119th Congress, with co-sponsors from both chambers. In the Senate, Sens. John Fetterman (D-Pa.) and Roger Marshall (R-Kan.) are co-sponsors. In the House, Reps. Diana Harshbarger (R-Tenn.) and Jack Auchincloss (D-Mass.) lead, with two Democrats and two Republicans signing on.
The bill would mandate that health insurers and pharmacy benefit managers divest any pharmacies they own. An earlier version died in committee during the 118th Congress but drew broad bipartisan interest. The new bill goes to the Senate Judiciary Committee and House Judiciary Committee. Two House co-sponsors sit on House Judiciary; two others serve on House Energy & Commerce, suggesting the committee will likely share jurisdiction.
Harshbarger, a pharmacist, has been vocal about PBM opposition. She told a Capitol Hill press conference in February that PBM lobbyists "turn around and go the other way" when she approaches.
The real cost pressure sits with PBM control of the pharmacy network
Warren frames the bill as a response to corporate greed in healthcare. Hawley argues that PBMs drive up costs while pushing out independent pharmacies. Neither claim is wrong, but the bill's opponents have a structural argument worth examining.
The Pharmaceutical Care Management Association, the PBM trade group, contends that drug manufacturers and wholesalers, not PBMs, drive cost inflation. More critically, they argue that forced divestiture would weaken PBM negotiating power with manufacturers and could disrupt specialty drug delivery chains. Job losses and supply chain friction are their secondary concern.
The tension is real. PBMs own pharmacies partly to integrate the supply chain and partly to secure pricing leverage. Removing that vertical integration could eliminate a negotiating tool. Whether that actually lowers costs for employers depends on whether competitive independent pharmacies can match the scale and bargaining power PBMs currently hold. History suggests consolidation often wins over fragmentation in healthcare.
Employers should prepare for a prolonged legislative fight with uncertain outcomes
The bill has bipartisan sponsors and momentum, but PBMs control 98% of US prescriptions and employ hundreds of thousands. Lobbying will be fierce. Even if the bill advances, implementation timelines and enforcement mechanisms remain undefined.
Benefits advisors should document current pharmacy network performance, rebate structures, and specialty drug pathways now. If divestiture happens, networks will realign. Understanding your baseline costs and outcomes before that shift gives you leverage in renegotiation and protects you against vendor claims that disruption was unavoidable.
Employers should also pressure PBMs to provide transparent cost data now. Regardless of whether Congress acts, you own the question of whether current PBM arrangements serve your plan members.