8/21/2025

Upcoming Pharmacy Benefit Manager (PBM) Reforms Could Impact Prescription Costs

There’s growing bipartisan momentum to reform Pharmacy Benefit Managers (PBMs) — and new regulations may be on the way in the next congressional session. These changes could significantly affect how prescription drugs are priced, reimbursed, and accessed.

What could change?

• Greater drug pricing transparency – Clearer breakdowns of costs and rebate structures.

• End to spread pricing – PBMs would no longer be allowed to charge employers more than the actual drug cost.

• Rebates applied at the point of sale – Could lower patient out-of-pocket costs, but may mean smaller rebate checks for employers.

• Regulation of prior authorizations – May make it easier to access certain medications, though higher utilization could increase plan costs.

• Restrictions on PBM-owned pharmacies – Aimed at reducing conflicts of interest and unfair pricing.

What this means for you:

• For employers: Potentially lower costs in some areas but changes in how pharmacy benefits are structured.

• For individuals: Possible reduced out-of-pocket prescription costs, but changes in coverage rules could affect access.

📞 Let’s make sure your health plan is ready for these changes.