Engaging Policymakers on Capitol Hill

ATAP – Drug Pricing – Federal – Comments – Senate Finance RFI (August 2026) ATAP Action Network responds to the Senate Finance Committee’s Request for Information by highlighting vertical integration abuses by the three largest PBMs, supporting legislation to break up such monopolies, require rebate pass-through, ban certain kickbacks, and extend Part D-style delinking to commercial markets, while again opposing the use of international reference prices in Medicare drug negotiations.

ATAP Supports the Pharmacists Fight Back Act (H.R. 9096) (May 2026) ATAP Action Network urges Congress to advance legislation requiring pharmacy benefit managers (PBMs) to pass 80% of manufacturer rebates directly to patients, lowering out-of-pocket prescription drug costs across Medicare, Medicaid, federal employee health plans, and TRICARE.

ATAP – MFN – Federal – Comments – Senate Reconciliation 2.0 (May 2026) ATAP Action Network urges Congress to reject Most Favored Nation proposals in Reconciliation 2.0, arguing that OECD reference prices are not comparable because those countries lack PBMs (which add roughly $7.3 billion in excess costs in the U.S.) and instead calls for expanding PBM reforms already enacted for Medicare Part D in the Consolidated Appropriations Act of 2026.

ATAP – PBMs – FTC – Comments – Express Scripts (March 2026) ATAP Action Network commends the FTC’s proposed Consent Order with Express Scripts for addressing anticompetitive practices and inflated rebates, and urges finalization of the order’s provisions on formulary placement, patient out-of-pocket costs, point-of-sale rebates, and delinking.

ATAP – Drug Pricing – CMS – Comments – GLOBE & GUARD (February 2026) ATAP Action Network opposes the proposed GLOBE and GUARD models that would set Medicare drug target prices based on the lowest prices in certain OECD countries, arguing that those countries lack PBMs and thus operate fundamentally different systems from the United States.

ATAP – Delinking – Federal – Comments – PBM Price Transparency and Accountability Act (December 2025) ATAP Action Network endorses S.3345’s provisions that would prohibit Medicare Part D PBMs from deriving income based on drug list prices, requiring flat, fair-market-value fees instead, so as to eliminate incentives to favor high-list-price drugs over lower-cost alternatives.

ATAP – Delinking – Federal – Comments – EOY Health Package (December 2025) ATAP Action Network urges House and Senate leaders to include two core PBM reforms in any year-end healthcare package—delinking Medicare Part D PBM compensation from drug list prices (via bills such as the PBM Reform Act, Patients Before Middlemen Act, and DRUG Act) and requiring 100% pass-through of manufacturer rebates and price concessions directly to patients to lower out-of-pocket costs.

ATAP – Delinking – Federal – Comments – 4C Lame Duck (November 2024) In a letter to congressional leaders, ATAP Action Network calls for inclusion of PBM delinking provisions (from the Modernizing and Ensuring PBM Accountability Act and related bills) and mandatory 100% rebate pass-through to patients in any lame-duck or year-end legislative package to eliminate incentives favoring high-list-price drugs.

ATAP – IRA – CMS – Comments – MDNP (July 2024) ATAP Action Network warns CMS that the Medicare Drug Price Negotiation Program may lead PBMs to favor higher-list-price non-negotiated drugs for greater rebate income and to apply heavy utilization management that undermines meaningful access to maximum fair price drugs.

ATAP – PBMs – FTC – Comments – Consolidation in Health Care Markets RFI (May 2024) ATAP responds to the FTC’s Request for Information on consolidation in health care markets by highlighting the market dominance of the three largest PBMs (approximately 80% combined share), their ability to impose one-sided contracts, and the resulting incentives that favor high-list-price drugs and prevent patients from realizing savings.

ATAP – IRA – CMS – Comments – MFP Implementation Follow-up (December 2023) ATAP outlines key implementation issues and questions for CMS regarding the Inflation Reduction Act’s Maximum Fair Price mechanism, covering drug selection (including treatment of rebates and utilization), establishment of the MFP using the price-concession definition, coverage and access once an MFP is set, potential unintended consequences, and ASP+8% biosimilar reimbursement.

ATAP – Delinking – Federal – Comments – SFC Modernizing Ensuring PBM Accountability Act (July 2023) ATAP writes in support of the delinking provision in Section 2 of the Modernizing and Ensuring PBM Accountability Act, which would bar Medicare Part D PBMs from earning income tied to drug list prices and require flat, fair-market-value fees instead, while also suggesting the committee consider requiring price concessions to be passed through directly to patients.

ATAP – PBMs – FTC – Comments – RFI (May 2022) ATAP responds to the FTC’s RFI by documenting how PBM rebates and fees exert upward pressure on list prices, shape formulary design and utilization management in ways that harm patients, and urging a comprehensive study that treats the patient—not the payer—as the PBM’s primary customer.

ATAP – Drug Pricing – CMS – Comments – MA-PD (March 2022) ATAP Action Network comments on the CMS proposal regarding definitions of “negotiated price” and “price concession,” highlighting the explosive growth of pharmacy price concessions (over 100,000% from 2010 to 2020) driven by performance-based contracts that often fall outside the point-of-sale negotiated price.

ATAP – PBMs – OPM – Comments – Drug Pricing Transparency (January 2022) ATAP Action Network comments on the interim final rule implementing section 204 of the Consolidated Appropriations Act, 2021, supporting a broad definition of “rebates, fees, and other remuneration” that requires disclosure of all payments received by plans or their PBMs, consistent with the statute’s lack of exemptions.

ATAP – PBMs – OPM – Comments – RFI Consolidated Appropriations Act (July 2021) ATAP urges OPM and the Departments to require full disclosure of all remuneration received by insurers and PBMs from manufacturers under section 204 of the Consolidated Appropriations Act, 2021, emphasizing Congress’s broad “any other remuneration” language and the absence of the exemptions found in earlier statutes.

ATAP – AAP – CMS – Comments – Revising Medicaid Drug Rebate Requirements (July 2020) ATAP provides feedback on the CMS proposal to require drug manufacturers to reflect the value of their patient assistance programs in Medicaid best-price and average manufacturer price calculations in light of accumulator adjustment programs, while taking no position on other aspects of the rule.

ATAP – Tiering – CMS – Comments – Medicare Rx Benefit Program (April 2020) ATAP comments on the CMS proposal to permit up to two specialty tiers in Part D plans, focusing on the high cost-sharing burdens for beneficiaries and the implications for the tiering exceptions process.

ATAP – Importation – FDA – Comments – Importation of Prescription Drugs Proposal (March 2020) ATAP provides feedback on the FDA’s proposed rule implementing Section 804 Importation Programs from Canada, strongly opposing any role for PBMs as SIP cosponsors while emphasizing that patient safety must remain the top priority.

ATAP – AAP – CMS – Comments – NBPP (March 2020) ATAP expresses concern with the CMS proposal in the 2021 Notice of Benefit and Payment Parameters to allow plans and PBMs to disregard manufacturer copay assistance when determining whether a patient has met annual cost-sharing limits, reversing the more limited 2020 policy that applied only when a medically appropriate generic was available.

ATAP – PBMs – CMS – Comments – Transparency in Coverage (January 2020) ATAP strongly supports the CMS Transparency in Coverage proposed rule’s requirements for providing patients with out-of-pocket drug cost information, noting that the rule sets a federal floor that preserves stronger state transparency laws and emphasizing the need for accurate, advance cost data to reduce prescription abandonment.

ATAP – RPT – Federal – Comments – Schrader Gianforte PBM Transparency in Rx Costs Act (December 2019) ATAP strongly supports H.R. 5304, which would increase transparency around formulary design and manufacturer payments to PBMs, limit the practice of spread pricing, and require pass-through of price concessions from PBMs to health-plan issuers.

ATAP – Delinking – Federal – Comments – HELP Health Plan Oversight of PBMs (July 2019) ATAP endorses Section 306 of S. 1895, which would require PBM transparency on manufacturer payments and formulary decisions, limit spread pricing, and mandate 100% pass-through of rebates and other remuneration to health plans, while urging that any allowed service fees be flat rather than percentage-based, citing a CBO estimate of net federal savings.

ATAP – Kickbacks – OIG – Comments – Rebate Rule (April 2019) ATAP comments on the HHS Office of Inspector General proposal to eliminate antikickback safe-harbor protection for manufacturer rebates to Part D and Medicaid managed-care plans (treating them as kickbacks) while creating new safe harbors for point-of-sale price reductions and certain flat PBM service fees.

ATAP – Delinking – Federal – Issue Brief – Health Plan Oversight of PBMs (2019) ATAP urges support for Section 306 of S. 1895, which would require PBM transparency on manufacturer revenues and formulary decisions, ban spread pricing, mandate 100% pass-through of rebates and other remuneration to health plans, and (as urged) limit service fees to flat amounts rather than percentage-based ones, citing CBO estimates of federal savings and lower plan costs and premiums.

ATAP – Drug Pricing – CMS – Comments – Part D Rule (January 2019) ATAP submits comments on the CMS proposed rule aimed at modernizing Part D and Medicare Advantage to lower drug prices and reduce out-of-pocket expenses, focusing on PBM-related reforms that affect patient access and costs.

ATAP – Drug Pricing – CMS – Comments – International Pricing Index Model (December 2018) ATAP opposes the Administration’s proposed International Pricing Index (IPI) demonstration for Medicare Part B drugs in its current form—a large-scale, mandatory model covering half of Part B drug spending—and urges either incorporation of strong patient-access safeguards or that the project not move forward.

ATAP – Gag Clause – Federal – Comments – Patient Right to Know Drug Prices Act (September 2018) ATAP strongly supports S. 2554 as introduced and urges senators to reject Senator Lee’s amendment that would limit the gag-clause prohibition to self-insured group plans, thereby leaving more than 14 million people in the individual market unprotected.

ATAP – Gag Clause – Federal – Comments – Collins Patient Right to Know Drug Prices Act (June 2018) ATAP endorses S. 2554, which would prohibit PBM “gag clauses” that prevent pharmacies from informing patients when a drug would cost less if purchased without insurance, and urges that the bill also address equivalent “non-disparagement” clauses that could produce the same effect.

ATAP – RPT – Federal – Comments – Cassidy RFI (March 2018) In response to a bipartisan RFI on healthcare transparency, ATAP emphasizes the unique lack of transparency and pass-through requirements for PBMs in the pharmaceutical supply chain, notes that patients rarely benefit from negotiated savings, and references the CMS Part D proposed rule’s request for information on point-of-sale rebate application.

ATAP – RPT – CMS – Comments – Medicare Rx Benefit Program (January 2018) ATAP comments on the CMS 2019 Part D proposed rule’s Request for Information on applying manufacturer rebates at the point of sale, advocating for pass-through of negotiated savings to reduce beneficiary out-of-pocket costs.

ATAP – RPT – Federal – Comments – HELP SFC WM EC (December 2017) ATAP urges multiple congressional committees to encourage CMS to advance its Part D proposed-rule concept requiring sponsors to include at least a minimum percentage of manufacturer rebates (and all pharmacy price concessions) in the negotiated price at the point of sale, citing CMS estimates of substantial beneficiary out-of-pocket savings that more than offset any premium increases.

ATAP – PBMs – Federal – Comments – EC PBM Principles (December 2017) In comments for a subcommittee hearing on the drug supply chain, ATAP outlines three core policy goals—greater transparency in the rebate system with agreed definitions and disclosure, flow-through of price concessions to reduce patient cost-sharing, and transparent, clinically driven formularies—while highlighting how opaque PBM practices allow reclassification of rebates and inconsistent brand/generic definitions that harm patients.

ATAP – PBMs – FTC – Comments – FTC Supply Chain Dynamics (December 2017) Following the FTC workshop on competition in U.S. prescription drug markets, ATAP criticizes the lack of transparency and pass-through requirements for PBMs, their growing consolidation, and their increasingly anti-competitive effects on pricing, access, and quality.

ATAP – PBMs – CMS – Comments – CMMI Innovation Center New Direction (November 2017) ATAP responds to the CMS Innovation Center’s RFI on a new direction, highlighting the harmful role of PBMs in the drug supply chain and supporting models that increase pricing competition, align incentives across the supply chain, and protect beneficiary access.

ATAP – PBMs – Federal – Comments – HELP PBM Principles (October 2017) ATAP outlines three policy goals for the HELP Committee—greater transparency in the rebate system through agreed definitions and public disclosure, flow-through of price concessions to reduce patient cost-sharing, and transparent, clinically sound formularies—while criticizing opaque PBM practices that allow reclassification of rebates and fail to benefit patients.

ATAP – RPT – Federal – Comments – Collins Rx Price Transparency Act (May 2017) ATAP endorses H.R. 1316 as an important first step to increase transparency in PBM-pharmacy interactions and prohibit self-dealing that forces beneficiaries into PBM-owned pharmacies, while expressing interest in broader rebate transparency and pass-through reforms similar to Senate legislation.

ATAP – RPT – Federal – Comments – Wyden C-THRU Act (May 2017) ATAP endorses the Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act, which would require public reporting of PBM rebates, discounts, and spread pricing, mandate a minimum percentage of those concessions be passed through to health plans, and base Medicare Part D beneficiary cost-sharing on the negotiated price rather than the list price.