PBM Reform Bill Seeks to Reduce Cost Barriers for Autoimmune Patients

On December 4, 2025, U.S. Senators Mike Crapo and Ron Wyden reintroduced bipartisan legislation to increase transparency and accountability among Pharmacy Benefit Managers (PBMs), the intermediaries that manage prescription drug benefits for insurers and federal programs.

For people living with autoimmune disease, PBM practices play a major role in determining whether essential medications are affordable and accessible.

Many autoimmune conditions require long-term use of high-cost or specialty therapies, and PBM decisions around formularies, tier placement, and pharmacy networks can directly affect out-of-pocket costs and continuity of care.

The PBM Price Transparency and Accountability Act targets several practices that have been linked to higher patient costs.

The bill would delink PBM compensation from drug rebates, reducing incentives to favor higher-priced medications. It would also expand reporting and audit requirements, giving federal agencies and plan sponsors greater visibility into how PBMs set prices and retain revenue. Additional provisions aim to protect pharmacy access by reinforcing “any willing pharmacy” requirements, which can help preserve patient choice, including access to independent and community pharmacies.

By addressing opaque pricing structures and limiting practices such as spread pricing, the legislation seeks to lower costs at the pharmacy counter and reduce disruptions in access to medically necessary treatments.

If enacted, the bill could ease financial strain and improve medication stability for people with autoimmune disease who depend on consistent, long-term therapy to manage symptoms and prevent flares.

Sources

U.S. Senate Finance Committee. Wyden, Crapo Introduce Bipartisan Pharmacy Benefit Manager Legislation (Dec. 4, 2025).

U.S. Congress. PBM Price Transparency and Accountability Act (2025).