Patient Organizations Push for PBM Reform
In the latest efforts to reform access to health care, patients and advocates call for transparency as well as an end to spread pricing and step therapy barriers.
March 7, 2025
On February 26, 2025, the House Energy & Commerce Committee Subcommittee on Health held a hearing titled An Examination of How Reining in PBMs Will Drive Competition and Lower Costs for Patients. As Congress examines potential solutions to the impacts of Pharmacy Benefit Managers (PBM), this hearing served as a key milestone for patients and patient advocates to engage in the process and ensure that their voices were heard. Witnesses for the hearing included:
• Mr. Hugh Chancy, RPh, Pharmacist and Owner, Chancy Drugs
• Mr. Shawn Gremminger, MPH, President and CEO, National Alliance of Healthcare Purchaser Coalitions
• Mr. Anthony Wright, Executive Director, Families USA
• Dr. Matthew Fiedler, PhD, Joseph A. Pechman Senior Fellow, Center on Health Policy, Brookings Institution
In preparation for the hearing, the Arthritis Foundation — in conjunction with seventeen additional patient organizations — sent a letter to the members of the Health Subcommittee, urging them to pass "meaningful PBM reform that ensures transparency and accountability for PBMs and their practices and prioritizes the needs of patients."
Specifically, the letter proposed the following provisions:
• Transparency and accountability to allow for systemic reform, and so that all stakeholders, including patients, are working with the same level of information to inform health care decision-making;
• Ban on spread pricing;
• De-linking PBM compensation from the cost of prescription drugs; and
• Address insurance-mandated step therapy practices that present barriers for patients accessing medically necessary medications.
The Arthritis Foundation remains committed to advocating for policies that protect all patients and ensure PBMs do not interfere with patients receiving the care and support they need.
To reach out to your legislators regarding policies, use the Arthritis Foundation’s Find Your Legislator Tool to identify your legislators and their contact information.
Read the full letter.
On February 26, 2025, the House Energy & Commerce Committee Subcommittee on Health held a hearing titled An Examination of How Reining in PBMs Will Drive Competition and Lower Costs for Patients. As Congress examines potential solutions to the impacts of Pharmacy Benefit Managers (PBM), this hearing served as a key milestone for patients and patient advocates to engage in the process and ensure that their voices were heard. Witnesses for the hearing included:
• Mr. Hugh Chancy, RPh, Pharmacist and Owner, Chancy Drugs
• Mr. Shawn Gremminger, MPH, President and CEO, National Alliance of Healthcare Purchaser Coalitions
• Mr. Anthony Wright, Executive Director, Families USA
• Dr. Matthew Fiedler, PhD, Joseph A. Pechman Senior Fellow, Center on Health Policy, Brookings Institution
In preparation for the hearing, the Arthritis Foundation — in conjunction with seventeen additional patient organizations — sent a letter to the members of the Health Subcommittee, urging them to pass "meaningful PBM reform that ensures transparency and accountability for PBMs and their practices and prioritizes the needs of patients."
Specifically, the letter proposed the following provisions:
• Transparency and accountability to allow for systemic reform, and so that all stakeholders, including patients, are working with the same level of information to inform health care decision-making;
• Ban on spread pricing;
• De-linking PBM compensation from the cost of prescription drugs; and
• Address insurance-mandated step therapy practices that present barriers for patients accessing medically necessary medications.
The Arthritis Foundation remains committed to advocating for policies that protect all patients and ensure PBMs do not interfere with patients receiving the care and support they need.
To reach out to your legislators regarding policies, use the Arthritis Foundation’s Find Your Legislator Tool to identify your legislators and their contact information.
Read the full letter.
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