Skipping The Foreplay On PBM Reform, Senator Hawley Calls Insurers Monopolists, And IRA Pushes Part D Exits

Hey all,

Happy Thursday! Today’s rundown is all about federal pharmaceutical price reforms. With multiple hearings yesterday we heard a lot of reasons that the big PBMs are bad for the market. Hopefully we see action from Congress but I won’t be holding my breath. Hat tip to Senator Kennedy of Louisiana for the best quote. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Healthcare Dive) Senate Judiciary Committee PBM Reform Hearing

Bipartisan senators renewed their push to overhaul pharmacy benefit managers (PBMs), accusing them of driving up drug prices, harming patient access, and putting independent pharmacies out of business through opaque practices and vertical integration. Lawmakers floated reforms from banning spread pricing to breaking up PBM-insurer-pharmacy conglomerates, with Sen. John Kennedy bluntly urging, “Why don’t we skip the foreplay and go right to the sex and outlaw vertical integration for Part D?” The hearing highlighted growing frustration with PBMs’ outsized power, and Chair Sen. Grassley signaled that serious legislative action could follow Trump’s summer policy bill. Full Article

(BenefitsPro) Senator Judiciary Committee Targets Insurer-PBM Alliances
Sen. Josh Hawley, R-Mo., called on Congress to dismantle the ownership ties between major insurers and pharmacy benefit managers (PBMs), arguing they operate as monopolies harming patients and driving independent pharmacies out of business. Speaking at a Senate Judiciary Committee hearing, Hawley criticized the consolidation—such as CVS owning both Aetna and Caremark—as exacerbating pharmacy deserts, particularly in rural Missouri, while PBM representatives claimed market pressures and employer demands are already reshaping pricing and rebate practices. “You're making $7.3 billion, you and the companies that you represent, and yet two whole counties in the state of Missouri have no pharmacies. Why should we be breaking you guys up? This looks like classic monopolist behavior: The patients are getting screwed, Missourians are getting screwed, and you're getting rich.” Full Article

(JAMA) Insurer Exits After Medicare Part D Redesign

A new study in JAMA reveals that 7.5% of Medicare Part D beneficiaries—nearly 2.9 million people—lost their drug coverage due to insurer exits following the Inflation Reduction Act’s 2025 redesign, which capped out-of-pocket costs but increased financial risks for insurers. The findings raise concerns that fewer standalone Part D plans and increased market exits could reduce coverage options and disrupt care, especially for vulnerable populations. Perhaps policymakers may need to consider reforms that don't involve funding green energy subsidies with fantasy drug savings. Full Article