A House subcommittee convened in April 2026 to examine a troubling practice in the pharmacy benefit management industry. The hearing revealed that brokers and benefit consultants hired to evaluate PBMs are often receiving direct payments from those same companies. This arrangement creates a clear conflict of interest, yet it has operated largely in the shadows for years.
Chris Deacon, a health benefits consultant and founder of VerSan Consulting, provided a striking example during her testimony. She cited a contract offering brokers $2.50 per retail prescription and $7 per mail order or specialty prescription. These payments reward volume and higher margins rather than better outcomes or lower costs for employers and patients.
The hearing highlighted how these compensation structures incentivize consultants to steer business toward PBMs that pay them the most. Employers believe they are receiving independent guidance, but the recommendations may be compromised from the start. Lawmakers from both parties expressed concern that PBMs have strayed from their intended role of managing costs and improving medication access.
The three largest PBMs now control 79 percent of all prescription claims in the United States. Their influence over formularies, rebate negotiations, and pharmacy networks makes transparency essential. Yet the system remains opaque, and conflicts of interest continue to distort recommendations.
New legislation called the PBM Kickback Prohibition Act would bar PBMs from paying brokers and consultants to direct employer plans toward preferred partners. The Department of Labor has also proposed new disclosure rules that would require reporting of direct and indirect compensation, rebates, and spread pricing arrangements.
At EZ Scripts Pharmacy, we believe transparency and ethical practices are essential to rebuilding trust in healthcare. We welcome reforms that align incentives with patient needs rather than corporate profits.
Source: https://www.planadviser.com/congress-take-aim-at-alleged-kickbacks-in-hearing-on-pbms/