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S4509119th CongressWALLET

PBM Act

Sponsored By: Senator Warren, Elizabeth [D-MA]

Introduced

Summary

Ends vertical integration between pharmacies and insurers or pharmacy benefit managers (PBMs). This bill would bar any person from owning or controlling a pharmacy and an insurer or PBM at the same time and would require divestiture of the pharmacy within one year.

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  • Consumers and communities: Would create an enforcement path to recover overcharges by requiring disgorgement of revenues from the violation period and by putting 10 percent of monthly profits into escrow if divestiture milestones are missed. Escrowed funds could be directed to a fund for harmed communities, including overcharged consumers.
  • Independent pharmacies and corporate owners: Would force companies that combine pharmacy ownership with PBMs or insurers to sell their pharmacies within one year, allow appointment of a divestiture trustee to oversee sales, and toll divestiture clocks during waiting periods.
  • Enforcement and legal remedies: Would give the Federal Trade Commission and Department of Justice joint and separate authority to enforce the rule, let state attorneys general and the HHS Inspector General bring actions, and create a private right of action with treble damages and attorneys’ fees. Courts could order injunctive relief, divestiture, and disgorgement to the FTC fund.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 4 benefits, 0 costs, 0 mixed.

Ban on pharmacies owned by insurers or PBMs

If enacted, this bill would make it illegal for the same person to own or control both a pharmacy and either an insurer or a pharmacy benefit manager. The rule covers direct and indirect ownership, operation, control, or direction. The ban would take effect when the law is enacted. If passed, this would aim to reduce conflicts of interest that can raise drug costs or limit pharmacy choice.

Divestiture rule with 10% monthly escrow

If enacted, any person found to violate the ownership ban would have to divest the pharmacy within one year after enactment. The FTC Chair and the Justice Department must give divestiture milestones within 30 days. Companies that miss milestones would have to transfer 10 percent of their monthly profits into escrow each month; escrowed funds are returned if the sale occurs on time, or are deposited into an FTC fund if not. The one-year deadline is tolled while any Clayton Act waiting period runs, and required divestitures must be reported under that framework.

Stronger enforcement and private lawsuits

If enacted, federal agencies and state attorneys general could sue to stop violations and force divestitures. The bill would let individuals bring private lawsuits with possible treble damages, attorney fees, and jury trials on request. Courts could order injunctions, divestiture, and disgorgement of prescription-drug revenues; disgorged money would go into an FTC-created fund to help harmed communities. The FTC must also write rules and report quarterly to Congress on compliance and divestitures.

Definitions for pharmacies and PBMs

If enacted, the bill would define a pharmacy broadly to include retail, mail-order, specialty, hospital, nursing home, long-term care, infusion, and similar licensed dispensers. It would define a pharmacy benefit manager by what the entity does, including negotiating drug prices or rebates, designing or managing pharmacy networks, processing claims, handling prior authorizations and appeals, or doing utilization and cost-control work. The law would also define 'health plan' as any public or private health insurance plan and use the Sherman Act definition of 'person'. These definitions would take effect on enactment and decide who must follow the ownership ban.

Sponsors & CoSponsors

Sponsor

Warren, Elizabeth [D-MA]

MA • D

Cosponsors

  • Sen. Hawley, Josh [R-MO]

    MO • R

    Sponsored 5/13/2026

  • Sen. Fetterman, John [D-PA]

    PA • D

    Sponsored 5/13/2026

  • Sen. Marshall, Roger [R-KS]

    KS • R

    Sponsored 5/13/2026

Roll Call Votes

No roll call votes available for this bill.

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