U.S. Representatives Jake Auchincloss (D, MA-04) and Ryan Mackenzie (R, PA-07), alongside Senators Roger Marshall (R-KS), Tim Kaine (D-VA), Chuck Grassley (R-IA) and Maggie Hassan (D-NH) introduced the bicameral PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act. This legislation would establish fiduciary responsibilities for pharmacy benefit managers (PBMs) – the middlemen of drug pricing – requiring them to act in the best interests of employees relying on employer-sponsored health plans, while keeping plan costs low.
 |
| U.S. Representatives Jake Auchincloss |
Currently, PBMs that provide drug benefits for employer health plans often get away with price-gouging because they are not legally required to put employees’ interests first. The PBM FAIR Act would ensure these middlemen are classified as fiduciaries under law, which will help curb hidden fees and practices that drive up what employees pay for their medications.
PBMs are directly responsible for:
- Marking up generic drugs at prices hundreds of times higher than actual cost,
- Limiting patient choice, and
- Denying claims with no or misleading explanations.
This bill reins in bad PBM practices and helps ensure employer-sponsored health care plans are affordable and accessible to all families.
“Instead of looking out for the best interests of employees, pharmacy benefit managers have been hitting them with prescription drug mark-ups, inconvenient pharmacy options, and wrongful denials,” said Congressman Jake Auchincloss. “This legislation puts force of law behind the best interest standard. The PBMs either improve access and affordability, or they'll pay out in lawsuits.”
“Pharmacy benefit managers play a major role in determining what patients pay for their prescriptions, yet they often operate with little accountability,” said Congressman Ryan Mackenzie. “The PBM FAIR Act brings transparency to the system by requiring PBMs to act as fiduciaries under ERISA, ensuring that patients come first. By holding middlemen accountable we can also deliver lower healthcare costs to policyholders."
“For too long, middlemen have used opaque pricing and misaligned incentives to line their own pockets at the expense of employers,” said Senator Marshall. “PBMs shouldn’t profit by steering plans toward higher‑cost drugs or practices that drive up prices. This bill holds them accountable and ensures that every decision they make prioritizes the health and financial interests of the plans and people they serve.”
“Pharmacy benefit managers should be held accountable for their role in raising costs of prescription drugs,” said Senator Kaine. “This bipartisan legislation is critical to ensuring that PBMs are doing what’s best for Americans who rely on lifesaving medication.”
This legislation is supported by the ERISA Industry Committee (ERIC).
“Employers, workers, and families should be able to rely on those who provide services to employer-sponsored group health plans, such as pharmacy benefit managers, to adhere to the same fiduciary duties the employer is held to. That means working to save money for patients, and doing what is right for the plan’s beneficiaries. Today’s unregulated, “honor system” approach is not working. When PBMs are performing services on behalf of the employer, they are standing in the shoes of the plan sponsor and should be held accountable. ERIC applauds Representatives Auchincloss and Mackenzie, and Senators Marshall, Kaine, Grassley, and Hassan for leaving politics at the door and taking a bipartisan approach to clarify this important extension of current law,” said James Gelfand, President and CEO, ERIC.
The full text of this legislation is available -> https://auchincloss.house.gov/imo/media/doc/pbm_fair_act.pdf
