Lawmakers want to break up some pharmacy companies. Here's why

A bipartisan group of lawmakers is renewing a push to target drug pricing middlemen by forcing some large pharmacy companies to break up parts of their business.

It's legislation that'll look familiar to people in Tennessee – a similar bill passed the Tennessee Legislature and awaits Gov. Bill Lee's signature. CVS Health has threatened to close all 134 of its pharmacy locations in Tennessee because the legislation takes aim at the pharmacy giant's business model.

On May 13, Sens. Elizabeth Warren, D-Massachusetts, and Josh Hawley, R-Missouri, reintroduced the Patients Before Monopolies Act. Under the legislation, companies that own a pharmacy benefit manager or an insurance company would be forbidden from owning a pharmacy.

The bill focuses on large health care companies that own pharmacies as well as insurers or pharmacy benefit managers, known as PBMs, which influence the prescription drugs Americans can get through insurance plans and how much those medications will cost.

Large companies that own health insurance companies also own the nation's three largest PBMs − CIGNA's Express Scripts, UnitedHealth Group's Optum RX and CVS Health's Caremark.

Warren and Hawley introduced a version of the bill in December 2024 but the legislation did not advance.

Under Warren and Hawley's bill introduced Wednesday, companies that jointly own PBMs or insurance companies and pharmacies would have one year to sell their pharmacy business. The original version allowed companies three years to divest part of their business.

The legislation also spells out enforcement steps the Federal Trade Commission, Health and Human Services Department, Justice Department and state attorneys general can take against companies that violate the legislation.

For Warren and Hawley, the bill addresses a narrower segment of the health care industry than their Break Up Big Medicine Act, which would prohibit PBMs, health insurers and drug wholesalers from owning medical providers or pharmacies.

In a statement, Warren said she expects the PBM legislation will gain momentum because "people are realizing that you can’t lower health care costs without tackling corporate greed in the health care system. It’s time we finally rein in the health care middlemen that are jacking up drug costs and driving small pharmacies out of business."

Hawley said PBMs are the "center of a broken system that rewards middlemen while driving up costs for patients and pushing out independent pharmacies."

He added the legislation would improve transparency and make health care more affordable for Americans.

Push to break up PBMs gains bipartisan support

U.S. Reps. Diana Harshbarger, R-Tennessee, and Jake Auchincloss, D-Massachusetts, introduced a companion version of the bill in the House of Representatives.

Sens. John Fetterman, D-Pennsylvania, and Roger Marshall, R-Kansas, signed on as cosponsors of the Senate bill. Reps. Greg Landsman, D-Ohio; Buddy Carter, R-Georgia; Jerry Nadler, D-New York; and Troy Nehls, R-Texas, are cosponsors of the House version.

Backers of the legislation cited nationwide momentum for PBM reforms.

In 2025, a coalition of 39 state attorneys general urged Congress to pass legislation to prevent companies from jointly owning pharmacies and PBMs. Also in 2025, Arkansas passed a bill that would prevent companies that own PBMs from operating retail pharmacies.

Tennessee Gov. Lee on May 11 received legislation passed by the state's House and Senate. He has 10 business days to sign the legislation, veto it or allow it to become law without a signature.

CVS spokesperson Amy Thibault said while the company would close Tennessee pharmacies if the legislation is enacted, those actions would not be immediate because the legislation would not take effect until July 2028. The company also is prepared to sue in federal court to block the legislation.

Thibault said CVS has not seen the Warren-Hawley legislation but noted the company provided a coordinated platform for 185 million Americans.

"We stand behind that and really feel our patients and members get value out of it," Thibault said.

The legislation would make it more difficult for patients to navigate a complex system, said Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a group representing pharmacy benefit managers.

“One of the things American patients and families most dislike about our health care system is how fragmented and complex it is, and this legislation would only make that problem far worse – sending patients into a deeper maze of discontinuous care," Lopes said.

In February, Congress passed legislation that ended the partial federal government shutdown and contained provisions addressing PBM transparency and business practices.

The legislation prohibited PBMs from collecting compensation based on the price of a drug, rebate or discounts under Medicare Part D. Instead, PBMs can collect a service fee only beginning in 2028, according to KFF, a health policy nonprofit.