Pharmacy Benefit Managers (PBMs) are facing increasing scrutiny and potential reforms in the United States. A recent House hearing highlighted that PBMs are a significant barrier to affordable medicines, inflating prices for life-saving drugs. The 'Pharmacists Fight Back Act' aims to block PBM practices that raise premiums and co-pays, bankrupting community pharmacies. Additionally, there are calls to de-link PBM fees from drug prices and volumes to reduce out-of-pocket costs. The Federal Trade Commission (FTC) has also criticized PBMs for profiting at patients' expense. Meanwhile, the Supreme Court's review of Medicare Part D preemption and other healthcare-related decisions could impact PBM regulations. Arkansas has taken legal action against PBMs, imposing $1.5 million in penalties for violations. Experts argue that regulators should consider the clinical and financial benefits for patients as they evaluate PBM mergers. The theme of 'busting up' PBMs is gaining traction for potential reforms in 2025.