WASHINGTON, D.C. – Rep. Earl L. “Buddy” Carter (R-GA) today celebrated President Trump’s signing into law key portions of Rep. Carter’s PBM Reform Act as part of the Consolidated Appropriations Act, 2026.
After more than a decade of advocacy, Rep. Carter’s efforts have resulted in a major win for patients and pharmacies that will increase transparency, preserve patient access to care, and lower health care costs by reforming the middlemen – pharmacy benefit managers (PBMs).
Rep. Carter stands beside President Trump during Consolidated Appropriations Act, 2026 bill signing
“As a pharmacist from coastal Georgia, I came to Congress with the goal of building a health care system that put patients before profits,” said Rep. Carter. “Today, I can proudly say that we have enacted the first major PBM reform in decades, a meaningful step toward achieving that goal. PBMs have been stealing hope and health from the American people for decades, inflating prescription drug costs, forcing pharmacy closures, and blocking access to medications. To that I say: Not on my watch. The PBM mafia has officially been put on notice. I’m excited to continue working with President Trump help build a quality, accessible, and affordable health care system for patients.”
Included in this funding package are Rep. Carter’s policies to:
- Prohibit PBMs and their affiliates from deriving remuneration for covered Part D drugs based on the price of a drug; Require PBMs to define and apply drug and drug pricing terms in contracts with Part D plan sponsors transparently and consistently; Set out annual requirements for PBMs to report on drug price and other information to Part D plan sponsor clients; and, Empower Part D plan sponsors with new audit rights with respect to PBMs.
- Promote price transparency for prescription drugs purchased by employer health plans by ensuring PBMs provide group health plans and issuers with detailed data on prescription drug spending at least semi-annually. Such data includes gross and net drug spending, drug rebates, spread pricing arrangements, formulary placement rationale, and information about benefit designs that encourage the use of pharmacies affiliated with PBMs. The section also ensures that health plans and individuals can receive a summary document regarding information about the plan’s prescription drug spending.
- Require Part D plans to allow any willing pharmacy that meets standardized, reasonable contract terms to participate in their networks, beginning in 2029, and direct CMS to gather input on contracting practices, ensure contract terms are fair, and improve oversight of pharmacy and plan relationships. Additionally, it establishes a new category of “essential retail pharmacies” in underserved areas and requires regular federal reporting on their reimbursement, participation in networks, and cost sharing impacts. It also establishes a formal process for pharmacies to report contract-related violations without fear of retaliation and authorizes enforcement actions and penalties against plans or PBMs that fail to comply.
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