U.S. Rep. Buddy Carter, a pharmacist representing a coastal Georgia district, is renewing his push to increase regulation of pharmacy benefit managers as Congress’ August recess draws to a close. Carter, a St. Simons Republican, held a roundtable with Federal Trade Commission Chair Andrew Ferguson and other industry representatives in Atlanta on Tuesday to highlight the need for change.
Pharmacy benefit managers are third-party businesses that serve as middlemen between health care providers, insurance companies and pharmacies and patients. They are tasked with helping insurance companies manage benefits for consumers and help set prescription drug prices for patients. The three biggest managers — CVS Caremark, Optum Rx and Express Scripts — processed almost 80% of all prescription claims in 2024.
But critics say that while these companies were established in an effort to reduce prices and increase efficiency, in practice they often do the opposite. A 2024 New York Times investigation found that pharmacy benefit managers frequently encourage patients to use more expensive medications, charge high markups on cheaper drugs and often drive independent pharmacies out of business.
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Carter, who is running for the U.S. Senate next year, introduced a bill in July that would prevent pharmacy benefit managers from charging Medicaid higher rates for medications than what they pay to pharmacies and increase reporting requirements for drug spending. It would also block them from steering Medicare patients toward their own affiliated specialty pharmacies.