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These state actions are important, but this is a nationwide problem requiring a comprehensive, federal solution. Congress should create a federal structure for the regulation of pharmacy benefit managers that includes at least two basic elements. First, PBMs should be required to assume a greater fiduciary responsibility to health plan sponsors. Second, they should be required to be transparent in their financial relationships. This would allow everyone in the health care system payers, providers and patients to know what theyre paying for and to make more informed decisions. These are simple steps toward a more market-oriented drug payment system. But they would have a dramatic, positive effect on nearly every health care stakeholder.Pharmacy benefit managers argue that, for every dollar they receive, they save clients far more. They may have identified some savings, particularly in their early years. However, this system has spun out of control and is now cloaked in darkness. Every quarter brings new reports of PBM profitability while health care costs continue to soar.Sunlights the best disinfectant, as they say. Now Congress can step up and shine a light of transparency to help address the countrys needlessly inflated health care costs. Health reform legislation offers an ideal opportunity to make Americas medicine market work better for everyone, root out wasteful spending and take a step forward for simple fairness. That will only occur when PBMs are required to be accountable and responsible for their actions.Bruce Roberts is executive vice president and CEO of the National Community Pharmacists Association.