The Biotechnology Innovation Organization announced on March 26 that its national voter survey found strong support for reforms to pharmacy benefit managers, including passing rebates and discounts directly to consumers and requiring PBMs and insurers to share negotiated savings with patients at the pharmacy counter.
The survey results indicate widespread public interest in changing how prescription drug savings are distributed. According to BIO, these findings highlight affordability concerns across the healthcare system.
BIO reported that 88% of voters support passing PBM and insurer rebates and discounts directly to consumers, while 87% support requiring PBMs and insurers to share negotiated savings with patients at the pharmacy counter. The survey also found 88% support for cutting waste and markups that raise premiums and medicine prices, indicating that PBM reform is one of the poll’s clearest affordability messages across the healthcare system.
Recent federal scrutiny has focused on major PBMs' pricing practices. The Federal Trade Commission said in January 2025 that the 'Big 3' PBMs marked up numerous specialty generic drugs by hundreds or thousands of percent at affiliated pharmacies, generating more than $7.3 billion in dispensing revenue above estimated acquisition cost from 2017 to 2022. The agency also said PBMs generated an estimated $1.4 billion from spread pricing on the drugs studied.
Further data show shifting revenue patterns among pharmacies linked to large PBMs. FTC staff said pharmacies affiliated with the three largest PBMs received 68% of the dispensing revenue generated by specialty drugs in 2023, up from 54% in 2016. In the same review, the FTC said plan sponsors paid $4.8 billion for specialty generic drugs in 2021, and patient cost sharing totaled $297 million, with both rising significantly over the study period, according to the Federal Trade Commission report.
BIO describes PBMs as prescription market "middlemen" whose practices increase drug prices and limit patient access to medicines. The organization says proposed reforms would target spread pricing, limit PBM income to service fees, make operations more transparent, address rebate distribution issues, prevent pharmacy closures, and reduce overall drug spending.
The Biotechnology Innovation Organization represents biotech companies, academic institutions, state biotech centers, and related organizations across the United States and internationally.
