(Georgia Recorder) — U.S. Rep. Buddy Carter, a pharmacist representing a coastal Georgia district, is renewing his push to increase regulation of pharmacy benefit managers as Congress’ August recess draws to a close. Carter, a St. Simons Republican, held a roundtable with Federal Trade Commission Chair Andrew Ferguson and other industry representatives in Atlanta Tuesday to highlight the need for change.
PBMs are third-party businesses that serve as middlemen between health care providers, insurance companies and pharmacies and patients. They are tasked with helping insurance companies manage benefits for consumers and help set prescription drug prices for patients. The three biggest PMBs — CVS Caremark, Optum Rx and Express Scripts — processed almost 80% of all prescription claims in 2024.
But critics say that while PBMs were established in an effort to reduce prices and increase efficiency, in practice they often do the opposite. A 2024 New York Times investigation found that PBMs frequently encourage patients to use more expensive medications, charge high markups on cheaper drugs, and often drive independent pharmacies out of business.
Carter, who is running for the U.S. Senate next year, introduced a bill in July that would prevent PBMs from charging Medicaid higher rates for medications than what they pay to pharmacies and increase reporting requirements for drug spending. It would also block PBMs from steering Medicare patients towards their own affiliated specialty pharmacies.
“We can bring down prescription drug prices if we simply eliminate the middleman and have more transparency,” Carter said.
Ferguson, the FTC chair, said that reining in PBMs is also a top priority for his agency.
“Yes, we want business to thrive, but at the end of the day, my job is to protect American consumers,” he said. “And every single American, every day of your life, is, in some sense, a consumer of our health care market.”
The FTC is currently in the middle of a lawsuit against CVS Caremark, Optum Rx and Express Scripts, claiming that the three companies are artificially inflating the cost of insulin.
Georgia has also attempted to introduce new PBM regulations on the state level in recent years. Last year, the Georgia General Assembly passed a bill that would have required the state health benefit plan’s PBM to reimburse independent pharmacists at similar rates to chain retail pharmacies. However, Gov. Brian Kemp ultimately vetoed the bill, arguing that it could cost the state Department of Community Health, which manages the state health benefit plan, up to $45 million per plan year, and that lawmakers had not set aside funding in the state budget.
