Overview
- Senators Elizabeth Warren and Josh Hawley reintroduced the Patients Before Monopolies Act, which would forbid companies that own a pharmacy benefit manager or an insurer from also owning a retail pharmacy.
- The proposal gives violators one year to sell their pharmacy business and adds automatic penalties, revenue disgorgement, forced asset sales, and lawsuits by federal and state enforcers as well as private parties.
- The measure targets the vertically integrated models of CVS/Caremark, Cigna/Express Scripts, and UnitedHealth/Optum RX, and it takes aim at PBMs that run drug benefits, shape formularies, and influence what patients pay.
- House members filed a companion bill with bipartisan sponsors, building on February’s new Medicare Part D rules that end PBM pay tied to drug prices or rebates and allow only service fees starting in 2028.
- Tennessee has sent a similar bill to Gov. Bill Lee and Arkansas passed a related law in 2025, and CVS has warned it would close 134 Tennessee pharmacies and go to court if the state measure becomes law, though any closures would not occur before the 2028 start date.