The moves follow intense public scrutiny over evidence that PBMs’ outsized—and opaque—influence in the pharmaceutical supply chain may play a large role in keeping drugs unaffordable for many Americans. But experts told Healthcare Brew it’s unclear whether such changes will lead to any substantial improvements in drug affordability anytime soon. PBMs are often called “middlemen” because they operate between drug manufacturers and health insurance plans. They negotiate with the manufacturers to create formularies, or lists of drugs that insurers agree to cover. They also help health plans adjudicate prescription claims, reimburse pharmacies for dispensed prescriptions, and decide which pharmacies are in network for a specific plan. However, PBMs often consider the details of their contracts with drugmakers as proprietary, which creates opacity for the health plans they…

As of July, the FTC has reached settlements with both Express Scripts and Caremark regarding the 2024 insulin lawsuit. Each settlement requires the PBMs to make changes such as increasing transparency in the data they provide to health plans. Optum has yet to reach a final settlement with the FTC, though it reached a tentative proposed consent agreement in June. The most significant pressure involved Congress passing a set of reforms in February. They were part of the Consolidated Appropriations Act of 2026 and required PBMs to make a number of changes to their business practices, including passing through 100% of rebates to their employer health plans and providing more data to health plans on their contracts with drugmakers. Rebates are what drugmakers typically pay a PBM in exchange for putting their drug on formularies. Rebate amounts are typically considered trad…