Antitrust Law Daily Wrap Up, ANTITRUST NEWS: Senators renew bipartisan push for PBM conflict of interest legislation, (May 15, 2026)

By Justin Marcus Smith, J.D.

Support for addressing pharmacy ownership conflict of interest appears to be growing.

Senators Elizabeth Warren (D-Mass.) and Josh Hawley (R.-Mo.), along with Representatives Diana Harshbarger (R-Tenn.) and Jake Auchincloss (D-Mass.), reintroduced the Patients Before Monopolies (PBM) Act on May 13, 2026. The PBM Act is intended to prohibit joint ownership of pharmacy benefit manager (PBM) entities and pharmacies. Sens. Warren and Hawley initially introduced the bill in December 2024 after the FTC issued a report, in July 2024, detailing how PBMs have gained significant power due to growing concentration and vertical integration (see Antitrust News, Dec. 16, 2024). The PBM Act has since gained expanded bipartisan support since last December. Many now view joint ownership of pharmacy benefit managers (PBMs) and pharmacies as a gross conflict of interest.

In a March 13, 2026 press release, Sen. Warren’s office said the legislation would address inherent conflict of interest by:

• prohibiting a parent company of a PBM or an insurer from owning a pharmacy business;

• requiring divestiture of pharmacy businesses within one year;

• empowering the Federal Trade Commission (FTC), Department of Health and Human Services, Department of Justice (DOJ), state attorneys general, and harmed individuals to enforce the law;

• directing the FTC to distribute any disgorged revenue to harmed communities, including to consumers overcharged at vertically integrated pharmacies;

• authorizing the FTC and DOJ to monitor pharmacy business divestment and impose monetary penalties for compliance failure; and

• mandating reporting of all divestitures to the FTC with FTC review.

Sen. Warren said the PBM Act is “gaining momentum because people are realizing you can’t lower health care costs without tackling corporate greed in the health care system.” She contends it is time to rein in PBM middlemen that increase drug costs while driving small pharmacies out of business.

Sen. Hawley essentially concurred that “PBMs are at the center of a broken system that rewards middlemen while driving up costs for patients and pushing out independent pharmacies.” He added that Americans deserve transparency and better affordability.

Rep. Harshbarger noted that, as a “lifelong pharmacist,” she has seen firsthand “how PBMs game the system.” She said the system is “rigged” when the same corporation that sets reimbursement rates also owns the pharmacy collecting them. She said Congress has “a duty to restore fair competition.”

Rep. Auchincloss echoed the apparently growing view that the PBM industry is “rife with self-dealing and price gouging” and that something must be done about “unacceptable” conflict of interest.

New cosponsors are said to include Senators John Fetterman (D-Pa.) and Roger Marshall (R-Kansas), along with Representatives Greg Landsman (D-Ohio) and Buddy Carter (R-Ga.) of the Committee on Energy and Commerce, and Jerrold Nadler (D-N.Y.) and Troy Nehls (R-Texas) of the Judiciary Committee. Rep. Nadler said he was “proud to support this bill reining in PBMs and enforcing fair business practices.”

Senator Warren’s office suggested the PBM Act will pass through the Committee on Energy and Commerce or the Judiciary Committee before going to the House floor under regular order.

Sen. Warren’s office noted that 39 state attorneys general have already urged Congress to pass an act prohibiting PBMs, parent companies, or affiliates from owning or operating pharmacies. In April, Tennessee passed a law to do just that, and, according to Sen. Warren’s office, the Tennessee Governor is expected to sign that bill into law soon.

Several organizations expressed their support for the PBM Act in Sen. Warren’s press release. They include: The American Pharmacy Cooperative, Inc.; Pharmacists United for Truth and Transparency; the Coalition of State Rheumatology Organizations; the American Economic Liberties Project; the Alliance for Transparent & Affordable Prescriptions; and pharmacy advocacy group American Pharmacies.

News: Antitrust AntitrustDivisionNews FederalTradeCommissionNews