Patients Before Middlemen Act

S. 882, the Patients Before Middlemen Act, would reform how pharmacy benefit managers (PBMs) are compensated under Medicare Part D prescription drug plans. Currently, PBMs often earn income based on the price of drugs, which creates an incentive for them to favor higher-priced medications. If enacted, this bill would require PBMs to receive only flat service fees that are not tied to drug prices, rebates, or discounts. The bill would also establish reporting requirements and enforcement mechanisms, including penalties for violations and protections for pharmacies that report unfair contract practices.

The legislation aims to address what supporters view as a misaligned incentive system in which PBMs profit when drug prices are higher, potentially driving up costs for Medicare beneficiaries at the pharmacy counter. The bill would require the Centers for Medicare and Medicaid Services to develop standards for contracts between drug plans and pharmacies, and would mandate transparency reporting on drug pricing and pharmacy networks. Supporters argue these changes could help lower prescription drug costs for seniors on Medicare, while the bill is currently under consideration by the Senate Finance Committee.