PBM reform caught in congressional funding fight as House vote looms

WASHINGTON — The future of long-sought pharmacy benefit manager (PBM) reforms now depends on House action this week after the U.S. Senate approved a sweeping funding package that includes the measures, but not before a partial government shutdown started due to unresolved Department of Homeland Security (DHS) funding.

The Senate approved the appropriations package late Friday with a 71–29 vote, moving forward with five regular funding bills while placing DHS funding into a short-term stopgap. Because the legislation still needs House approval, funding for parts of the federal government expired at midnight.

U.S. Senate advances PBM middleman reforms to lower drug prices and protect pharmacy access

House action now needed to send landmark PBM reforms to President Trump’s desk.

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For pharmacy advocates, the delay has raised concerns that landmark PBM reforms — widely regarded as the most important federal action on PBMs so far — could be threatened if the broader funding debate stalls or breaks apart.

“These reforms are on the brink of becoming law,” said Steven Anderson, president and CEO of the National Association of Chain Drug Stores, which has urged the House to act quickly. NACDS has warned that further delay would prolong practices that drive up drug costs and threaten pharmacy access nationwide.

The PBM provisions are part of the must-pass appropriations package and include new transparency rules, limits on spread pricing, enhanced oversight of PBM compensation, and protections related to pharmacy reimbursement and network participation across Medicare and the commercial market.

However, those healthcare reforms are now linked to a larger political deadlock over immigration enforcement and DHS funding. While Senate leaders recovered most of the funding package by separating DHS appropriations, House approval is still needed before the bill can go to President Donald Trump for signing.

Industry groups say the consequences of delay are not abstract. FMI – The Food Industry Association has warned that without comprehensive PBM reform — especially action on reimbursement and spread pricing — financially strained supermarket and community pharmacies may continue to close, reducing patient access to care.

FMI urges Congress to pass PBM reform to protect supermarket pharmacies

Meaningful reform must address three key issues: transparency, fair pharmacy reimbursement, and ending PBM spread pricing.

Chain Drug ReviewCDR

House leaders are likely to consider the Senate-approved package as soon as lawmakers return, possibly using a fast-track procedural vote that would need broad bipartisan backing. Until then, PBM reform remains caught in the middle of a funding dispute that goes beyond health care policy.

PBM reform has rarely been closer to passing. But as Congress faces a partial shutdown and ongoing DHS funding issues, the result of this week’s House vote will decide whether long-promised changes to drug pricing and pharmacy reimbursement become law or are postponed again.