Congress restricts pharmacy benefit managers to try to lower drug prices

The spending package passed by Congress includes new restrictions on pharmacy benefit managers, the large companies that oversee prescription benefits. The three largest — CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx — collectively oversee some 80 percent of prescriptions, and lawmakers and employers have criticized P.B.M.

practices for favoring higher-priced drugs and limiting patient access. Key changes apply to Medicare and the private market. Beginning in 2028, P.B.M.s will be paid flat fees rather than a percentage of a drug’s list price; other provisions require disclosure of how employers’ money is used and require benefit managers to pass rebates back to the employers that hire them.

The bill also includes measures to protect independent pharmacies and gives Medicare new authority to investigate complaints. The nonpartisan Congressional Budget Office estimated the P.B.M.

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