Congress Made Important Strides on PBM Reform, But More Must Be Done
WASHINGTON, DC – Insurance Watchdog Coalition (IWC) today issued a statement in firm support of the bipartisan inquiry led by the House Committees on Oversight and Reform into the predatory practices of Pharmacy Benefit Managers (PBMs).
We encourage Chairman James Comer (R-KY) of House Committee on Oversight and Government Reform and House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Chairman Robert Aderholt (R-AL) to keep pursuing insurance and PBM reforms that reduce prescription drug costs for patients.
While the recently signed Consolidated Appropriations Act, 2026 (passed February 3, 2026) represents a significant step in the right direction toward reforming PBM “black box” accounting, many PBM profit schemes remain intact. IWC encourages Congress to take swift action to address these practices and deliver real savings for American employers, taxpayers and healthcare programs.
Insurers and PBMs continue to utilize many predatory tactics identified in the Committee’s 2024 investigation into PBMs such as:
- Prior Authorization Abuse: Administrative hurdles used to override doctors and steer patients to profitable drugs.
- “Fail-First” Mandates: Forcing patients onto ineffective drugs before accessing prescribed, life-saving therapies.
- The Medicaid Gap: The new law fails to ban “spread pricing” in Medicaid, leaving low-income patients vulnerable to hidden PBM markups.
- Patient Steering: Mandating use of PBM-owned mail-order pharmacies, undermining local community access.
IWC hopes that Congress will prioritize addressing these harmful practices that decrease healthcare access and affordability.
Mark Merritt, executive director of the IWC, stated: “We are encouraged by the momentum that exists in Congress to address insurer and PBM predatory practices and are thankful for the Trump Administration’s commitment to addressing the rampant fraud and abuse within the American insurance marketplace. We need reforms now so patients can get their medications without jumping through hoops or paying sky-high insurance co-pays at the pharmacy counter.”
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Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.