Profits Over Patients: The PBM Business Model Under Scrutiny

The House Committee on Education & Workforce held a hearing on April 23, 2026, to examine the business practices of pharmacy benefit managers (PBMs) and their impact on prescription drug costs for employer-sponsored health plans. The discussion focused on the opaque financial arrangements between PBMs, brokers, and consultants, including kickbacks that may incentivize steering employers toward preferred PBMs, thereby raising drug prices. Witnesses and committee members highlighted the need for greater transparency, fiduciary responsibility for PBMs, and legislative reforms such as the PBM Kickback Prohibition Act to prohibit referral fees and conflicts of interest. The hearing also addressed the broader issue of high drug prices driven by pharmaceutical manufacturers and the lack of protections for commercial health plans compared to Medicare. Bipartisan support was expressed for reforms to increase disclosure, reduce conflicts, and extend negotiated drug price protections to employer plans. The committee emphasized the urgency of addressing these issues to lower costs and improve patient access to medications.