Senators Call on FTC to Release Second PBM Report
Ahead of its first general meeting in 2025, lawmakers called on the FTC to vote “yes” on releasing a second interim staff report on PBMs.
A group of bipartisan senators issued a letter to Federal Trade Commission (FTC) Chair Lina Khan asking to release a second interim staff report on pharmacy benefit managers (PBMs). According to a press release,1 senators addressed the letter ahead of the organization’s January Open Commission Hearing, featuring an agenda set for the FTC to discuss issues surrounding PBMs, among other topics.2
“PBMs were originally created to handle the prescription drug benefit on behalf of health plans, negotiating directly with drug manufacturers and setting pharmacy networks for their contracted payers,” wrote the release.1 “But over the years, these once little-known middlemen have morphed into giant, vertically integrated conglomerates that control every link in the drug coverage and delivery chain, including pharmacies and health plans.”
The letter focused on the FTC’s oversight and ability to hold PBMs accountable for their scrutinized practices. | image credit: gguy / stock.adobe.com
The PBM reform issue continues in 2025 as opposers of these pharmaceutical middlemen show persistence when it comes to advocating for federal legislation. The recent call to action from Senators Elizabeth Warren (D, Massachusetts), Josh Hawley (R, Missouri), Diana Harshbarger (R, Tennessee), and Jake Auchincloss (D, Massachusetts) focused on the FTC’s oversight and ability to hold PBMs accountable for their scrutinized practices.
Prior to the Commission’s January hearing, the confirmation of a second interim staff report will only be “considered” at the January 14 meeting.2 Serving as a way to further cement the lawmakers’ desirefor PBM reform, they are again asking the FTC to strike down on PBMs and vote “yes” to a second report.1
“In June 2022, the FTC launched an inquiry into the industry, requiring the 6 largest PBMs—which manage nearly 95% of all prescriptions filled in the United States—to provide information on their business practices and contractual arrangements to determine their effect on the affordability of prescription drugs,” according to the news release.1
With the FTC’s investigation lasting over 2 years, it finally released an initial staff report on PBMs, detailing several corrupt practices and highlighting the immense market power held by the top 6 PBMs in the industry, with an even deeper focus on the top 3—CVS Caremark, Express Scripts, and Optum Rx.3 Now entering a new year where advocates and lawmakers continue to call for PBM reform, they hope the FTC can serve as a medium for change.
“We expect a second interim report will shine further light on the industry that will be invaluable to legislators as the policy priorities of the 119th Congress take shape,” said the senators.1
From an upcoming presidential administration that described PBMs as “famous middlemen” that “rip off” patients, to PBM reform that was included in Congress’ end-of-year spending package, the reigning-in of PBMs seemed hopeful late in 2024. But after announcement of the official 2025 spending package, PBM reform was not included, leaving a disheartening outcome for PBM opposers to end the year.
“Numerous federal and state investigations—arising from concerns raised by policymakers and enforcers on both sides of the aisle—have found that the largest PBMs have used their market dominance to overcharge taxpayers and employers, hide profits in overseas entities, and squash competition from independent community pharmacies,” wrote authors of the letter.4
Of the 4 lawmakers supporting a second FTC report, Senator Warren has been especially active in the fight against PBMs. According to the release, Warren has been questioning the tactics of PBMs since the summer of 2021, when she led a group that questioned PhRMA's lobbying efforts to block policies that would lower drug costs for millions of Americans.1
Since then, she has written numerous letters in support of PBM reform, introduced legislation designed to take power away from prescription drug middlemen, and so much more. But she is certainly not alone in this anti-PBM narrative, along with other politicians, advocacy groups, pharmacists, and patients. With continuous movement to steer PBMs away from their money-grabbing tactics, their opposing parties hope that industry-wide change comes in 2025.
“The FTC’s interim report helped inform various bipartisan proposals to rein in abuses in the PBM market, including our Patients Before Monopolies (PBM) Act,” concluded the lawmakers in their letter.4 “Accordingly, we urge FTC to issue its second interim staff report swiftly and continue investigating the serious effects of the PBM industry on patients, taxpayers, and independent pharmacies.”
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