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Benham: Study shows more Pharmacy Benefit Managers reforms needed

Author of PBM overhaul legislation weighs in on new state insurance report

Rep. Jessica Benham    May 21, 2026 | 4:55 PM

HARRISBURG, May 21 – In 2024, Gov. Josh Shapiro signed Rep. Jessica Benham’s legislation regulating Pharmacy Benefits Managers into law as Act 77. As part of the requirements of the Act, the state Insurance Department conducted a study of the pre-Act 77 commercial insurance market in Pennsylvania, including the impacts of patient steering, spread pricing, and reimbursement rates on overall drug spending and chain and independent pharmacies.

Benham issued the following statement on the findings of the report:

“I applaud the work of the Insurance Department in promptly completing a study that provides a solid understanding of potential next steps in regulating the often-predatory middlemen known as Pharmacy Benefit Managers that control most of our prescription drug market,” Benham said. “I’m enthusiastic to see that there is a lack of evidence for the use of financial incentives to steer patients away from independent pharmacies, but there are still concerns.

“While spread pricing – PBMs taking an outsized profit share of each medication prescribed driving up the total spend on drugs to insurers and consumers – is declining in impact on spending and on independent pharmacies the data shows that some PBMs still do engage in significant spread pricing, an issue that policymakers will continue to address.

“The study also notes that non-financial incentives, like auto enrollment, may be driving some patient steering. As Act 77 prohibits some of this behavior, further analysis of the post-Act-77 commercial insurance market will be helpful to understand the ways in which patients’ choice of pharmacy are being limited.

“Most promisingly, the study demonstrates that a reimbursement floor of the national average drug acquisition cost (NADAC) plus a $10.49 fee – which means pharmacies  are being reimbursed the average cost of the medication plus a bit extra – would add minimal cost to the drug spending marketplace, while having an outsized impact on the financial stability of independent pharmacies, decreasing the number of potential closures and reducing the possibility of growing pharmacy deserts.

“Ultimately, Act 77 only regulated PBMs within the commercial insurance market, and I remain steadfast in my calls for additional state reforms. I remain enthusiastic about legislation that has been introduced to require the use of a single PBM for Medicaid, as we have seen other states save significant amounts of money within their Medicaid systems by moving to a single PBM, allowing additional investments into the stability of the pharmacy system. I am also currently working on legislation that would improve and clarify audit requirements for PBMs, reducing the potential for harmful clawbacks of reimbursements to pharmacies. However, this study also makes clear that we should take action to set a reimbursement floor within the commercial insurance space, which I am also proud to support.”