Who is lobbying to shape PBM (pharmacy benefit manager) reform in Congress right now? Map the organizations for and against, the bills in play, and the lobbying money, cited to the official record.

PBM Reform Lobbying Landscape (119th Congress)

Active Bills — Five major PBM reform proposals are in play:

  • H.R. 4317 - PBM Reform Act of 2025 (Rep. Carter, R-GA; referred to Energy & Commerce, Education & Workforce, Ways & Means)
  • S. 3549 - PBM FAIR Act (Sen. Marshall, R-KS; referred to HELP)
  • S. 4509 - PBM Act (Sen. Warren, D-MA; referred to Judiciary)
  • S. 3822 - Break Up Big Medicine Act (Sen. Warren, D-MA; referred to Judiciary)
  • S. 526 - Pharmacy Benefit Manager Transparency Act (Sen. Grassley, R-IA; referred to Commerce)

AGAINST PBM Reform (Defending Status Quo)

Top Spenders:

  • CVS Health - $6.89M (H.R. 4317), $3.57M (S. 4509) — CVS owns Aetna and operates as an integrated PBM-insurer-pharmacy. Lobbying against breakup provisions and fiduciary duties.
  • Pharmaceutical Care Management Association (PCMA) - $6.58M (S. 3549), $3.28M (S. 4509), $3.30M (H.R. 4317) — Trade association representing PBM industry; actively opposing transparency and fiduciary requirements across all bills.
  • America's Health Insurance Plans (AHIP) - $3.01M (S. 4509), $8.33M (S. 3822) — Represents health insurers; opposes restrictions on PBM-insurer vertical integration.
  • Chamber of Commerce - $16.95M (S. 3822) — Broad business opposition to antitrust/breakup provisions.

Strategy: Defending PBM compensation opacity, opposing fiduciary duties, and resisting vertical integration restrictions. CVS and PCMA are the primary defensive forces.

FOR PBM Reform (Pharmacy & Patient Advocates)

Top Spenders:

  • National Association of Chain Drug Stores - $610K (H.R. 4317), $290K (S. 4509) — Supports transparency and reimbursement fairness.
  • National Community Pharmacists Association - $320K (H.R. 4317), $590K (S. 3549), $270K (S. 4509) — Advocates for independent pharmacy access and fair reimbursement.
  • Independent Pharmacy Cooperative - $100K (H.R. 4317 & S. 3345), $100K (S. 4509) — Supports all major reform bills.
  • Patient advocacy groups (Cystic Fibrosis Foundation, Blood Cancer United, National MS Society) - $250K-$590K combined — Support reform to lower patient out-of-pocket costs.

Strategy: Pushing for transparency mandates, fiduciary duties, and restrictions on spread pricing and direct-to-consumer rebate practices.

Mixed/Nuanced Positions

  • American Medical Association - $21.58M (S. 3822) — Opposes vertical integration (supports breakup provisions) but may oppose other transparency mandates.
  • Amgen, Lundbeck, EMD Serono - $5.02M, $130K, $820K respectively — Pharmaceutical manufacturers support PBM reform to reduce rebate capture and improve drug access.
  • Cardinal Health, McKesson, Cencora - $1.78M, $1.39M, $1.66M — Drug distributors have mixed interests; oppose some provisions but support supply-chain transparency.

Lobbying Intensity by Bill

BillTop SpenderAmountTotal Filings
H.R. 4317CVS Health$6.89M50 filings
S. 3549PCMA$6.58M21 filings
S. 4509CVS Health$3.57M9 filings
S. 3822AMA$21.58M50 filings

H.R. 4317 and S. 3822 are drawing the most lobbying activity, with S. 3822 (the breakup bill) attracting the highest single-filer spend from AMA.

Key Takeaway

The PBM reform fight pits integrated PBM-insurers (CVS, UnitedHealth via AHIP) and the PBM trade association (PCMA) against independent pharmacies, patient advocates, and some manufacturers. The debate centers on three issues: (1) transparency of PBM compensation, (2) fiduciary duties to plan sponsors, and (3) vertical integration restrictions. Lobbying spending is heavily weighted toward the defensive side — CVS and PCMA alone account for ~$20M in disclosed filings across the bills.

Sources:

Sources

  1. H.R. 4317 § 2 - PBM Reform Act of 2025 (Congress.gov)
  2. S. 3549 (b) - PBM FAIR Act (Congress.gov)
  3. S. 526 § 4 - Pharmacy Benefit Manager Transparency Act of 2025 (Congress.gov)
  4. H.R. 8779 § 1 - PBM Act (Congress.gov)
  5. S. 4509 § 1 - PBM Act (Congress.gov)
  6. H.R. 4409 § 4 - Fair Pharmacies for Federal Employees Act of 2025 (Congress.gov)
  7. S. 3822 § 5 - Break Up Big Medicine Act (Congress.gov)
  8. H.R. 9645 (G) - (i) - Health Care Price Certainty for All Americans Act (Congress.gov)
  9. H.R. 8840 § 364 - Fair Care Act of 2026 (Congress.gov)
  10. H.R. 6837 (b) - To amend the Employee Retirement Income Security Act of 1974 to ensure that pharmacy benefit managers are considered fiduciaries, and for other purposes. (Congress.gov)
  11. S. 3349 (a) - PBM Disclosure Act (Congress.gov)
  12. H.R. 6610 § 2 - Pharmacists Fight Back [in Federal Employee Health Benefit Plans Act] (Congress.gov)
  13. S. 882 § 3 - Patients Before Middlemen Act (Congress.gov)
  14. H.R. 2041 § 3 - Hidden Fee Disclosure Act of 2025 (Congress.gov)
  15. S. 891 § 2 - Bipartisan Health Care Act (Congress.gov)
  16. Lobbying Activity — s-3549 (Senate LDA)
  17. Lobbying Activity — s-4509 (Senate LDA)
  18. Lobbying Activity — hr-4317 (Senate LDA)
  19. Lobbying Activity — s-3822 (Senate LDA)

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