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For the PBM reforms in the recently-enacted appropriations law, CBO estimated a total federal deficit reduction of $2.12 billion over 10 years (2026-2035): A reduction of $444 million from delinking PBM compensation from the cost of medications for drugs under Part D and establishing PBM transparency and reporting requirements for Part D plans An increase of $188 million from assuring pharmacy access and choice for Medicare beneficiaries A reduction of $1.865 billion from increasing oversight of PBMs that work with employer health plans, including $1.843 billion in additional revenues and savings of $22 million For the provision to increase oversight of PBMs that work with employer health plans, a prior CBO estimate of this provision assumed that because insurers had more information about the operations of their PBMs, it would lead to a reduction in prescription costs, and therefore a modest reduction in premiums charged in the group health insurance market, though savings would likely diminish over time

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