Q&A: Congressman Highlights PBM Reform Bill | McKesson ideaShare

At McKesson ideaShare, held from July 10 to 13, 2025, in Nashville, Tennessee, Congressman Buddy Carter (R-GA), BSPharm, a pharmacist turned legislator, discussed the PBM Reform Act of 2025, a comprehensive legislative package targeting the complex and often opaque practices of pharmacy benefit managers (PBMs). With a focus on drug price transparency, cost reduction, and enhancing the role of pharmacists in health care delivery, Carter outlined 4 key bills designed to address systemic inefficiencies in the pharmaceutical supply chain. Drawing from his professional background and legislative experience, Carter articulated a vision for a more accessible, affordable, and patient-centered health care system that leverages the expertise of pharmacists and introduces much-needed accountability to PBM operations.

Congressman Buddy Carter (R-GA) champions the PBM Reform Act of 2025, aiming to enhance drug price transparency and empower pharmacists in healthcare delivery. | Image Credit: Nuthawut - stock.adobe.com

Drug Topics®: There have been a few bills on PBM reform introduced in Congress. Can you elaborate on how these bills aim to increase transparency and accountability within the PBM industry and improve patient access to medications?

Buddy Carter, BSPharm: Just this week, as a matter of fact, we introduced the PBM Reform Act of 2025, and it includes 4 different bills that are extremely important. First of all, Drug Price Transparency and Medicaid Act, which is going to prohibit spread pricing and Medicaid, and it's going to save almost $3 billion, so it's very significant. Also, as part of it has the PBM Accountability Act, which is another savings of almost $3 billion, and it includes transparency for employers and for plan sponsors. This is very important, because as employers and plan sponsors begin to see the egregious practices of the PBMs, they're going to demand that those savings be shared with their patients and with them, so this will be very important as well, and also it has the Protecting Patients Against PBM Abuses Act, which will delink the price that the PBMs are paid for a drug from the percentage of the drug to just a flat fee. This will save over $500 million, and we think it will save even much more than that, but the way it's being scored by CBO shows only $500 million so that's important to note as well, and then finally, the NO PBMs Act, which really doesn't have a monetary impact; however, what it does do is give CMS the opportunity to review contracts and make sure that the PBMs are being fair and reasonable in their compensation.

Drug Topics: As one of the only pharmacists in Congress, you've been a strong advocate for pharmacist provider status. How crucial is it for pharmacists to be recognized as providers, and what specific benefits would this bring to the health care system and patient care, especially in underserved areas?

Carter: The best answer to that is look what we did during the pandemic. I am so proud of our profession. I'm so proud of how we stepped up and provided health care to people who truly needed it during the time when accessibility to health care was really impacted, and yes, we do deserve to have provider status. That's why I've worked so diligently on making sure that we get just that: the ECAPS [Equitable Community Access to Pharmacist Services Act] that's being proposed and championed by Representative Adrian Smith from Nebraska, and the Ways and Means Committee is extremely important and will help us to be compensated for what we've been doing over the years and what we've been doing for an awful long time, and that is advising patients. When it comes down to it, people, whether you're Republican, Democrat, or Independent, we all want the same thing on accessible, affordable, quality health care. When you talk about pharmacists, you're talking about almost 90% of Americans live within 5 miles of a pharmacy. They are pharmacists, the most accessible health care professionals in America, and when they start going away, when rural, independent retail pharmacies start going away, or when the chains start closing stores, then you're impacting accessibility to health care.

Drug Topics: As more states pass legislation limiting PBM practices, what can we expect to see happen at the federal level?

Carter: Well, first of all, I applaud the states, Arkansas, what they've done just with the legislation to prohibit PBMs from owning pharmacies, that is really encouraging for all the other states and really leads them to follow suit and to hopefully enact legislation similar to that as well. There is an important role for the federal government to play, particularly when you're talking about us being a payer in Medicaid, Medicare, and part of the fastest-growing part of our budget, and as everyone knows, we've got a budget deficit that we've got to address. So if we can get these costs under control and at the federal level, then it's going to help tremendously with all Americans.

Drug Topics: What is your reaction to the Supreme Court declining to review the Oklahoma PBM reform case?

Carter: Well, while we were disappointed, we still remain optimistic. There's been a lot of good reform done at the state level. I mentioned Arkansas; that's certainly a big win for us, and there are other examples that we can point to. So yes, Oklahoma was a disappointment, but not all that surprising. When I served in Georgia State Legislature, we had a lot of problems with ERISA [Employee Retirement Income Security Act of 1974] and with having some of the laws that we passed apply to the private sector, soreally that one is understandable, even though it is disappointing.

Drug Topics: Beyond legislation, what other initiatives or programs do you support to strengthen the role of pharmacies as essential health care hubs in rural America?

Carter: There's no question about it. Look, if we're ever going to get health care costs down in America, we've got to utilize all facets, all professions, in health care to the top of their license. That's going to be very important. Doctors remain the quarterback. They remain the captain of the team, but at the same time, we've got to utilize all the allied health [care]; we've got to utilize all of the different health care sectors in America, especially pharmacists, and especially let them practice at the top of their license.

Drug Topics: Is there anything else you would like to add?

Carter: Just wanted to thank all of the pharmacists they are. Advocacy is the key. Congress is a citizen legislature. We've got 2 pharmacists, we've got 2 urologists, we've got new car sales, we've got farmers, got way too many lawyers. But the point is every day I have someone come up to me, a member of Congress, and they say, I didn't know you were pharmacist. I had a pharmacist in my office. They said, "You got a letter I need to sign on to, so I'm going to have my staff call your staff and get on that letter." That's what helps inviting members of Congress, whether it be a Senator or whether it be a House member, to your practice setting, showing them the value that you bring to health care because you do bring value to health care and how important it is to your patients.

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