A bipartisan group of US lawmakers has introduced legislation that would prohibit health insurance companies and pharmacy benefit managers, known as PBMs, from owning pharmacies, forcing the unwinding of vertically integrated arrangements that have come to dominate the country's drug supply chain.
The Patients Before Monopolies Act, filed as House Resolution 8779, is backed by Sens. Elizabeth Warren, a Massachusetts Democrat, and Josh Hawley, a Missouri Republican, along with Reps. Jake Auchincloss of Massachusetts and Diana Harshbarger of Tennessee.
Under the bill, affected companies would have one year from enactment to complete divestitures. Federal agencies and state attorneys general would be empowered to sue to enforce compliance, with automatic penalties including disgorgement of profits and forced asset sales for those that miss the deadline.
Penalty proceeds would be distributed by the Federal Trade Commission and the US Department of Justice to affected communities, including consumers said to have been overcharged at pharmacies owned by their own insurers or PBMs.
The two agencies would also be authorized to block future transactions that could recreate the anticompetitive structures the bill targets. Independent pharmacists and other private parties would be able to sue violators directly and recover treble damages if they prevail in court.
"PBMs are at the center of a broken system that rewards middlemen while driving up costs for patients and pushing out independent pharmacies," Hawley said in a statement. He framed the bill as a step toward restoring transparency and making healthcare more affordable for working Americans.
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Warren said the legislation would rein in the "healthcare middlemen" she argued were inflating drug costs and squeezing out independent pharmacists.
Her language echoes earlier comments from President Donald Trump, who has likewise described PBMs as middlemen and suggested that removing them would lower prescription prices.
A similar bipartisan effort was introduced in 2024, the current sponsors noted. Since then, state legislatures across the country have pursued their own legislation, though not without industry pushback.
Arkansas passed a law in April 2025 mirroring key provisions of HR 8779, only to see it challenged in court. A judge later blocked the statute from taking effect, and the state is appealing.
State enforcement actions are also intensifying. Louisiana Attorney General Liz Murrill in February 2026 announced a $45 million settlement with CVS, CaremarkPCS Health and affiliated entities, resolving lawsuits that alleged coercive contracts, under-reimbursement of independent pharmacies, patient steering to CVS-owned facilities and spread pricing.
The Pharmaceutical Care Management Association, which represents PBMs, said the legislative focus on its members has come at the expense of other actors in the drug supply chain. The trade group argued that wholesalers exert significant influence over drug availability and pricing but receive comparatively little scrutiny.
That influence is most acute in the generic drug segment, the PCMA said, which accounts for more than 90% of annual US prescriptions.
The group contended that wholesalers operate under misaligned incentives in generics, where markups typically range from 10% to 15% and high volumes make the category more profitable than branded medicines.
