Savannah Standard

U.S. Rep. Earl L. “Buddy” Carter (R-GA-1) said that the insurance industry is “fighting like hell” to prevent legislation that would reform the Pharmacy Benefit Management (PBM) industry.

“Big insurance is fighting like hell to keep bipartisan PBM transparency and accountability reforms out of the CR because they’re putting profits over patients,” Carter posted on X. “We can’t let them win.”

The “CR” is the Continuing Resolution being considered in both houses of Congress to avert a government shutdown on Dec. 20.

Carter’s post was in response to a video of President-elect Donald Trump (R) saying on NBC’s Meet the Press that, ‘We’re going to reduce prices, because the middleman makes more money than the drug companies.”

“There's a middleman that nobody even knows who they are,” said Trump.

The “middleman” being referred to by Trump is PBMs. 

A PBM is a third-party administrator of prescription drug programs for health insurers, self-insured employers, and government agencies. PBMs negotiate with drug manufacturers to secure discounts and rebates on medications, manage pharmacy networks, and process prescription drug claims. PBMs also provide services such as medication therapy management and mail-order pharmacy services.

“There are around 70 PBMs in the U.S.,” reported NPR in July 2023. “Through mergers, three of them — CVS Caremark, Optum Rx, and Express Scripts — have come to control 80% of the prescription drug market, and each brings in tens of billions of dollars in revenue annually.”

Carter’s and Trump’s comments came the same week U.S. Reps.  Diana Harshbarger (R-TN) and Jake Auchincloss (D-MA) introduced a bill called the “Patients Before Monopolies (PBM) Act,” which would prohibit PBMs from owning pharmacies.

“As a life-long pharmacist, I know first-hand how unchecked PBM consolidation and vertical integration have allowed these shadowy middlemen to self-deal and manipulate the system in ways that are driving up drug costs, limiting patient choices, and putting the financial screws to independent community pharmacies,” said Harshbarger.