Jennifer Riley, Executive Director of Patients Come First PA, said in an op-ed that Congress’s bipartisan pharmacy benefit manager (PBM) reforms were necessary to prioritize patients and protect community pharmacies by increasing transparency and accountability in prescription drug pricing.
The issue of PBM reform has gained attention due to concerns about rising patient costs and the impact on local pharmacies.Â
According to Riley, “I want to applaud Congressman John Joyce for his leadership on pharmacy benefit manager (PBM) reform and for standing up for patients and community pharmacies in Pennsylvania. Congress passed PBM reforms that will bring long overdue transparency and accountability to prescription drug pricing.”
Congress included a suite of PBM reforms in the Consolidated Appropriations Act of 2026, signed on February 3, 2026. The law adds semiannual reporting requirements for employer plans regarding rebates and spread pricing, expands annual reporting and audit rights in Medicare Part D, and creates protections allowing any willing pharmacy to participate—measures intended to increase transparency and access.
Riley said, “PBM practices have driven up patient out-of-pocket costs while reimbursing pharmacies below the cost of care, contributing to pharmacy closures across Pennsylvania.”Â
According to Alphanet, a key driver for reform has been the rise of Direct and Indirect Remuneration fees in Medicare Part D. These fees increased by an estimated 45,000% between 2010 and 2017 according to CMS data cited by pharmacy groups. Policymakers say this trend has destabilized community access to medicines.
The Federal Trade Commission’s interim staff report finds that the six largest PBMs manage over 90% of U.S. prescriptions—with the top three handling nearly 80%. The report details how PBMs can raise drug costs for patients and impose contract terms that challenge independent pharmacies.
Riley concluded her remarks by saying, “This action sends a clear message that patients, not middlemen, should come first.” Patients Come First PA is a health care advocacy group focused on improving access and affordability for patients across Pennsylvania, with Riley serving as executive director.
