Congress is considering several bipartisan, common-sense reforms for holding PBMs, to account. Legislation could even pass before the end of this year – to the great benefit of millions of patients and small business owners nationwide.

PBMs are companies employed by insurers to design and administer prescription drug "formularies." In other words, these companies are in charge of deciding which medications are covered by a health plan and making sure insurers reap maximum profit from them.

Over the years, the industry has consolidated to an alarming degree. Today, the three largest PBMs — CVS

Caremark, OptumRx, and Express Scripts — control nearly 80% of the market.

The purpose of PBMs is to use their buying power to obtain discounts and rebates from drug makers. Pharmaceutical companies doled out $334 billion in rebates and discounts on brand-name drugs in 2023 alone.

But please don’t think those discounts get passed on to patients at the pharmacy. They don’t.

In the first place, they are largely illusory. Because drug makers know they will need to offer discounts, they increase the list prices of their drugs accordingly.

Those theatrics are fine with the PBMs, whose revenue depends in part on the size of the discount they negotiate.

In recent years, PBMs have also enriched themselves by charging pharmacies and small businesses ever more extravagant fees for their "services."

Add it all up, and PBMs have created a system that forces patients and companies to pay twice for their medicines. First, in the form of premiums and administrative fees. Then out-of-pocket at the pharmacy counter.

One proposed bill would shed new light on the secretive tactics PBMs use to maximize their own profits at the expense of patients and employers. It would also de-link PBM compensation from the price of a given drug under Medicare Part D, removing the incentive for PBMs to block access to low-cost generics.

A separate bill would base patients’ out-of-pocket drug costs under Part D on the discounted net price of a drug. That would ensure that PBMs and insurers share drug rebates and price cuts directly with patients, instead of hoarding them for themselves.

With these two bills, lawmakers have a chance to deliver cheaper medicines.

Angela Dingle is president & CEO of Women Impacting Public Policy, a national nonpartisan organization that advocates on behalf of women entrepreneurs. This originally ran in RealClearHealth