Press Releases

Reps. Celeste Maloy (R-UT), Raja Krishnamoorthi (D-IL), and Diana Harshbarger (R-TN) introduced the Pharmacy Audit and Compensation Transparency (PhACT) Act directing the Secretary of Health and Human Services to thoroughly investigate how Pharmacy Benefit Managers audit pharmacists and make recommendations for more transparency and fairness.

“Independent pharmacies are essential to Main Streets in Utah and across the country. But many have been forced to close their doors thanks to unfair PBM audits that lack clear metrics,” said Rep. Maloy. “My bill will increase transparency and help us find policy solutions, so pharmacists don’t have to worry about being able to provide for their patients or make a living.”

"Pharmacy Benefit Managers (PBMs) have been taking advantage of independent pharmacies for years through opaque business practices, including their unfair audits of independent pharmacies," said Rep. Krishnamoorthi. "This behavior has forced the closure of thousands of community pharmacies and denied necessary prescription drug coverage to millions of Americans. I am proud to join Congresswoman Maloy in shedding light on PBM audit practices to ultimately benefit independent pharmacists in Illinois and across the country."

“As a pharmacist, I know firsthand how PBMs often use aggressive audit practices as a weapon to harass independent small pharmacies and claw back reimbursements for their own financial gain,” said Rep. Harshbarger. “I also hear from constituents about how PBMs use trivial findings from endless audits to justify kicking a patient's preferred local pharmacy from their insurance coverage. For community pharmacists, it’s like playing a high-stakes game without knowing the rules—or worse, with no rules at all! That’s why I’m proud to help introduce the Pharmacy Audit and Compensation Transparency Act, which will require a comprehensive study of PBM audit practices and recommend fair, transparent, and accountable guidelines.”

“The Utah Pharmacy Association (UPhA) which represents hundreds of pharmacists and pharmacy technicians across Utah, including many pharmacy owners, is very appreciative of Congresswoman Maloy and her work on PBMs and PBM audits,” said Adam Jones, Executive Director of the Utah Pharmacy Association.  “The Pharmacy Audit and Compensation Transparency Act which directs the Secretary of Health and Human Services to conduct a thorough investigation of PBM audits and make recommendations for fairness and transparency is a step in the right direction to help keep pharmacy doors open. We know that it doesn’t immediately solve the issues facing pharmacy but provides tools to help government make decisions benefiting pharmacies and patients. There is much that needs to be done to keep pharmacy doors open and providing opportunities for transparency and proper audit reviews and reimbursements by PBMs is crucial. Congresswoman Maloy’s work on this topic and her willingness to have conversations with the pharmacy profession shows her dedication to finding solutions for the people that she represents in Utah.”

“Audits of pharmacies are often used as an additional revenue source for PBMs, a bullying tactic that targets community pharmacies and recoups vast sums of money for what are often nothing more than harmless clerical errors. Unfortunately, audits are becoming broader, more frequent and increasingly aggressive. NCPA is thankful to Representatives Maloy, Krishnamoorthi, and Harshbarger for introducing this legislation, pushing for transparency into this exploitative PBM practice, and working to lessen the burden on pharmacies,” said Anne Cassity, Senior Vice President of Government Affairs at the National Community Pharmacists Association.

Background:

When pharmacists sell medicines to insured customers the insurance companies reimburse Pharmacy Benefit Managers (PBMs) who in turn reimburse pharmacists. PBMs – the middlemen of drug pricing – often audit pharmacists when issuing these reimbursements. These audits lack clear metrics and often include requirements without clear medical rationale. Pharmacists widely report these audits are a pretense for withholding additional reimbursement funds.

PBMs have been reimbursing independent and other retail community pharmacists at lower rates each year for nearly a decade. In some cases, these reimbursements have fallen to lower than the cost of the medicines. Many pharmacists report failing PBM audits as the primary reason they cannot stay in business. More than 2,000 pharmacies closed in 2024, and one in three independent pharmacists are considering closing their doors for good.

The PhACT Act will ensure that Congress crafts the right policy to make these audits fair and more transparent for independent pharmacists across the country. 

Full text of the legislation can be found here.

A one-pager of the bill can be found here.