December 3, 2025
The Honorable Bill Cassidy, Chairman
Senate Committee on Health, Education, Labor & Pensions
428 Senate Dirksen Office Building, Washington, DC, 20510
The Honorable Bernie Sanders, Ranking Member
Senate Committee on Health, Education, Labor & Pensions
428 Senate Dirksen Office Building, Washington, DC, 20510
Dear Senators Cassidy and Sanders,
We write today on behalf of the Pharmaceutical Industry Labor-Management Association (PILMA), which unites skilled union workers and leading biopharmaceutical companies in support of a strong and innovative American life sciences sector.
Our organization thanks you for your leadership and continued focus on healthcare affordability by holding this week’s hearing, Making Health Care Affordable Again: Healing a Broken System. As the committee examines the drivers of high healthcare costs – which strain the finances of patients and their families, as well as employers, unions, and governments that pay a significant share of healthcare expenses – we encourage you to continue focusing on the need for transparency and reform in the pharmacy benefit manager (PBM) marketplace.
Last year, bipartisan PBM reform came closer than ever before to becoming law. The time is now to ensure meaningful PBM reform finally crosses the finish line.
The unions and companies of PILMA recognize that a strong domestic biopharmaceutical industry, one that delivers innovative and affordable medicines, is essential to the health and well-being of the American people. At the same time, we acknowledge the importance of addressing issues of shared concern to the industry, its workforce, and all Americans, including access to medicines and the affordability of those medicines.
PBM reform represents one of the clearest and most effective opportunities to provide relief to American workers and their families. The current prescription drug system is unsustainable, with rising costs placing a profound strain on working people and their families, including the skilled pipefitters, electricians, ironworkers, and other tradespeople who build America’s pharmaceutical manufacturing infrastructure. Employer-sponsored and union-managed health plans, long considered the gold standard of American healthcare benefit, are feeling this strain even as they continue to provide comprehensive coverage for millions of American workers and retirees.
Today, over half of prescription drug spending goes not to manufacturers, but to insurers, PBMs, and other middlemen. Harmful practices used by these middlemen, such as spread pricing, withholding rebates meant for patients, and steering prescriptions to affiliated pharmacies, undermine the value of union- and employer-sponsored health plans and drive-up costs for working families. We cannot allow the unchecked power of middlemen to continue inflating costs and undermining access for hardworking Americans.
We urge Congress to confront PBMs directly and decisively and restore fairness and accountability to our healthcare system. These bipartisan policies will make healthcare more affordable for American workers, lower costs for employers, and save money for taxpayers. Now is the time for meaningful action to rein in the middlemen who have distorted the system and increased costs for working people.
Thank you again for your committee’s attention to these important issues.
Sincerely,
AJ Stokes Executive Director,
Pharmaceutical Industry Labor-Management Association (PILMA)