Republican lawmakers in Wisconsin have unveiled new legislation aimed at reining in Pharmacy Benefit Managers (PBMs), the powerful middlemen in prescription drug pricing. Senator Mary Felzkowski and Representative Todd Novak announced Cole’s Act, a reform bill designed to increase transparency and accountability within the PBM industry, which they argue is driving up costs for patients and putting independent pharmacies at risk.

PBMs were originally created to negotiate lower drug prices on behalf of insurers and consumers. However, critics argue that their influence has grown unchecked. According to the bill’s sponsors, 89% of prescription drug claims are controlled by the three largest PBMs (CVS Caremark, OptumRx, and Express Script), which are owned by major healthcare conglomerates that also operate large pharmacy chains. This market dominance, they claim, has led to practices that harm consumers, such as restricting access to medications, imposing burdensome fees on small pharmacies, and manipulating drug coverage to maximize profits.

The proposed legislation introduces several key reforms, including:

• Preventing PBMs from reimbursing pharmacies below the cost of prescriptions.
• Protecting independent pharmacies from excessive fees and retaliation for reporting violations.
• Ensuring fair access to preferred and non-preferred pharmacy networks.
• Establishing fiduciary responsibility to insurers that hire PBMs.
• Requiring that co-pay assistance coupons apply toward patients’ deductibles.
• Restricting PBMs from unexpectedly removing medications from coverage mid-year.
• Protecting 340B providers—organizations that serve low-income and uninsured patients—from PBM practices that siphon away taxpayer funds meant for community healthcare.

Supporters argue that Cole’s Act would provide much-needed protections for independent pharmacies and consumers while increasing oversight of an industry that has operated largely unchecked. The bill follows a growing national trend of bipartisan efforts to reform PBM practices, as lawmakers across the country recognize the impact these entities have on drug pricing and healthcare access.

As the bill moves forward in the Wisconsin Legislature, it is expected to draw opposition from PBM industry groups, which have long defended their role in managing drug costs. However, with public frustration over rising prescription prices at an all-time high, Cole’s Act could gain traction as lawmakers seek to deliver meaningful healthcare reform.