Tennessee lawmakers recently passed a bill banning PBMs from owning pharmacies in the state, though like a similar Arkansas law, it is expected to face legal challenges if enacted.

The post Will Tennessee’s PBM Bill Face the Same Fate as Arkansas’ Law? appeared first on MedCity News.

In the latest episode of the Debunked Podcast, the discussion revolved around the Break Up Big Medicine legislation to rein in healthcare giants and ways to introduce meaningful PBM reform.

The post Debunked Episode 24: PBM Reform Brainstorm, Elevance Faces CMS Penalty Risk, Hims & Hers’ Eucalyptus Deal Takeaways appeared first on MedCity News.

Experts say the bipartisan Break Up Big Medicine Act — aimed at breaking up vertically integrated healthcare companies — faces slim chances of passing despite recent PBM reforms.

The post It Took Years for Congress to Enact PBM Transparency, Delinking. What About Vertical Integration? appeared first on MedCity News.

The Consolidated Appropriations Act of 2026 and the Department of Labor’s proposed rule implement major PBM reforms for employers, but don’t include everything they want, including a ban on spread pricing.

The post Employers Celebrated PBM Reform. The Reality Is More Complicated appeared first on MedCity News.

A coalition of major pharmacy organizations urged Congressional leaders to enact long-stalled PBM reforms to curb anti-competitive practices, lower drug costs and stop accelerating pharmacy closures that are limiting patient access to care.

The post Coalition of Pharmacy Groups Urges Congress to Enact PBM Reform appeared first on MedCity News.

The Trump administration can immediately take these two price transparency administrative actions to reduce costs and improve affordability.

The post President Trump Can Act Now To Make Healthcare Affordable appeared first on MedCity News.

A bipartisan Senate bill would boost transparency and oversight of pharmacy benefit managers by changing how they’re paid, expanding reporting requirements and strengthening protections for pharmacies and taxpayers.

The post Senators Introduce Bipartisan Bill to Increase Oversight of PBMs appeared first on MedCity News.

When control over prescription drug access rests with only a few players, the result is not just market imbalance — it is higher plan costs, increased financial pressures, and ultimately reduced affordability for patients.

The post The Path to Fair PBM Competition appeared first on MedCity News.

With federal PBM reform stalled, states like California are stepping up with laws like SB 41 to boost transparency and lower drug costs.

The post California Signs PBM Law: As Federal PBM Regulation Lags, the States Step Up appeared first on MedCity News.

Here are five guidelines to help employers balance health outcomes and financial responsibility to ensure that GLP-1 coverage is effective, affordable, and aligned with improved health and workforce well-being for employees and their families.

The post How Employers Can Build an Effective GLP-1 Strategy appeared first on MedCity News.

In a new analysis, the American Medical Association detailed the lack of competition among pharmacy benefit managers and their high level of vertical integration with insurers.

The post New AMA Report Highlights Lack of Competition in PBM Market appeared first on MedCity News.

White bagging not only creates significant uncompensated administrative burden and scheduling challenges for providers, but it also delays or limits access to necessary medication for patients.

The post White Bagging: A Prescription for Disruption in Care appeared first on MedCity News.

CalPERS has entered into a five-year agreement with CVS Caremark, who will provide outpatient prescription drug benefits for about 587,000 members enrolled in basic or Medicare HMO or PPO plans.

The post CalPERS Selects CVS Caremark as PBM, Replacing OptumRx appeared first on MedCity News.

A bill introduced by Rep. Earl L. “Buddy” Carter would ban PBMs’ use of spread pricing in Medicaid, among other reforms.

The post New Bipartisan Bill from Rep. Carter Aims to Crack Down on PBMs appeared first on MedCity News.

Arkansas became the first state to pass a law banning pharmacy benefit managers from owning pharmacies, aiming to curb their market power and reduce drug costs. But major PBMs like CVS and Express Scripts are suing, claiming the law is unconstitutional.

The post Why CVS, Express Scripts Are Suing Over the Arkansas PBM Law appeared first on MedCity News.

UH Group replaces its CEO, the payer’s alleged nursing home practices, the future of pharmacy benefit managers, and the healthcare implications of the budget bill are part of the latest episode of the Debunked Podcast with MedCity News Editor-in-Chief Arundhati Parmar and Samir Batra, managing partner of Health Innovation Pitch.

The post Debunked Episode 16: Will Trump Administration’s Drug Pricing Policies Lead to the End of PBMs? appeared first on MedCity News.

Abarca Health is paying attention to specialty drugs, AI in healthcare, the impact of obesity-related conditions, and increased government regulations.

The post 4 Prescription Drug Trends that are Top of Mind for One Abarca Exec appeared first on MedCity News.

Several healthcare provisions, including drug reforms, were left out of the government funding bill, angering some healthcare leaders.

The post Healthcare Leaders Slam Exclusion of Key Healthcare Provisions in Spending Package appeared first on MedCity News.

Congress released a stopgap funding bill with a significant healthcare package, and provider groups are reacting favorably. They are mainly applauding provisions that reign in PBMs’ business practices, extend telehealth flexibilities, and boost payments to hospitals and physicians.

The post How Did Provider Groups React to Congress’ End-of-Year Healthcare Package? appeared first on MedCity News.

Senators Elizabeth Warren and Josh Hawley and Representatives Diana Harshbarger and Jake Auchincloss introduced the Patients Before Monopolies Act on Wednesday. It aims to prohibit the parent company of a PBM or insurer from owning a pharmacy business.

The post Senators, Representatives Introduce Bill That Would Ban Joint Ownership of PBMs and Pharmacies appeared first on MedCity News.

Experts agree that the incoming Trump administration will likely shake things up in the prescription drug world — most notably when it comes to research and development, drug pricing and PBM reform.

The post What Might the Future of Prescription Drugs Look Like Under Trump? appeared first on MedCity News.

How are employers tackling the current landscape of healthcare costs? We turned to Shawn Gremminger, CEO of the National Alliance of Healthcare Purchaser Coalitions, a group of regional coalitions representing self-insured employers large and small that cover roughly 40 million people.

The post MedCity Pivot Podcast: Chat With Shawn Gremminger About Employer-Led Healthcare appeared first on MedCity News.

Months before the FTC sued the three largest pharmacy benefit managers, the CEO of Blue Shield of California battled its PBM – CVS Caremark – to bring a lower cost prostate cancer drug to its members.

The post Video: Why the FTC’s Lawsuit Against PBMs May Have Some Legs appeared first on MedCity News.

The Federal Trade Commission has sued CVS Caremark, Express Scripts and Optum Rx, alleging that they engage in “anticompetitive and unfair rebating practices” as it relates to insulin. One legal expert believes the FTC might win this legal battle.

The post The FTC Is Suing PBMs Over Insulin Prices. Will It Be Successful? appeared first on MedCity News.

The American Medical Association released a new report on Monday on pharmacy benefit managers. It explained that there is low competition among PBMs and high vertical integration with payers.

The post AMA Report Details Low Competition in PBM Market appeared first on MedCity News.

Losing these retail medication outlets creates more than just pharmacy deserts. In many low-income and underserved areas, drugstores also serve as grocery stores and hubs for essential services, and hence their closures mean communities lose crucial access points for a variety of goods and services.

The post There is Still a Significant Need for Community Pharmacies appeared first on MedCity News.

Any successful response to skyrocketing drug costs has to also actively manage medications at the individual level — just because someone can be on a medication doesn’t mean they should be.

The post It’s Time to Actively Manage Medications at the Individual Level appeared first on MedCity News.

We can’t wait for others to find a solution to high drug prices. It’s clear what should happen in a functioning drug pricing market federally and in California, but it is not happening today.

The post Three Ways Drug Pricing Should Work in a Functioning Market, But Isn’t appeared first on MedCity News.

The Federal Trade Commission recently released an interim report that details how the practices of pharmacy benefit managers negatively impact patients and pharmacies. Some experts hope for legislative action based on the report.

The post The FTC Released a Scathing Interim Report on PBMs. What’s Next? appeared first on MedCity News.

Multiple stakeholders are to blame for prescription drug costs, including pharmaceutical companies and PBMs, according to Merith Basey, executive director of Patients for Affordable Drugs.

The post Who Is Responsible for the High Cost of Prescription Drugs? One Advocate Weighs In appeared first on MedCity News.