04/19/2026
Putting Patients First Starts with Accountability!!
Many patients are surprised to learn that their doctor isn’t always the final decision‑maker when it comes to prescriptions. In many cases, that power sits with Pharmacy Benefit Managers (PBMs)—private companies that manage drug benefits for insurers and government programs.
PBMs often control which medications are covered, require prior authorizations, or force patients to try other drugs first. While intended to control costs, these practices can delay care, especially serious care like cancer treatment, by putting non‑medical barriers between patients and their physicians.
That’s where CMS, the Centers for Medicare & Medicaid Services, comes in.
CMS oversees Medicare and Medicaid and sets the rules for how prescription drug plans operate. Because PBMs work within these federal programs, CMS has the authority to enforce patient protections, improve transparency, and ensure timely access to medically appropriate care.
Thanks to recent bipartisan PBM reforms, CMS now has stronger tools to rein in harmful PBM practices. Cancer and chronic illness are not political, they are human. And patient care should never be delayed by paperwork or profits.
The newly passed FY26 Labor, Health and Human Services, Education, and Related Agencies Appropriations Act includes bipartisan reforms aimed at regulating PBM's in ways that protect the physician‑patient relationship and put clinical judgment back where it belongs: with doctors and patients. We appreciate the hard work of James Comer (R-Ky) and Robert Aderholt (R-Ala.) on spearheading the investigation on PBM's and the lack of transparency into their practices.
Putting patients first means:
✅ Timely access to care
✅ Respect for medical expertise
✅ Accountability for those who manage benefits
Health care works best when patients, not systems, come first.
