The White House announced that congressional bill H.R. 7148 has been signed into law, which includes reforms targeting pharmacy benefit manager (PBM) practices by shifting compensation away from rebate-linked incentives and expanding transparency requirements, an issue gaining attention in New Jersey.
According to AJMC, the spending law introduces Medicare Part D PBM reforms designed to reduce incentives tied to higher list prices. The policy “delinks” PBM compensation from rebates and list prices by moving PBMs toward flat administrative fees, a change supporters say can weaken “rebate maximization” and steer plans away from higher-priced drugs that generate bigger rebates.
Under the new provisions described in coverage of the law, PBMs would be required to pass through 100% of rebates, fees, and other remuneration to the payer, with Centers for Medicare & Medicaid Services (CMS) monetary penalties available for noncompliance. The goal, as reported by AJMC, is to ensure rebate dollars do not remain with middlemen and to improve accountability for how savings are handled.
PBMs sit between insurers/payers, drug manufacturers, and pharmacies—negotiating rebates and building formularies and pharmacy networks that shape what patients pay and where they can fill prescriptions. Federal scrutiny has intensified: the FTC’s interim staff report on “prescription drug middlemen” argues PBM concentration and vertical integration can disadvantage patients and independent pharmacies without sufficient transparency.
New Jersey’s Division of Consumer Affairs reported dispensing patterns suggesting the “Big 3” PBMs may steer highly profitable prescriptions to their own affiliated pharmacies. The same analysis estimated PBMs generated about $1.4 billion via spread pricing—billing plan sponsors more than they reimburse pharmacies—an incentive structure that can squeeze independents.
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