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Pharmacy Times
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Meaningful reform was challenging in 2024, but this year could turn the tide.
Pharmacy benefit managers (PBMs) have taken center stage in discussions about the future of pharmacy because of their controversial business methods. PBMs have traditionally been considered to beneficially serve as middlemen between insurance companies and pharmacies, helping with claims processing and price negotiating. However, critics argue that PBMs often attain maximum profits at the expense of patients by inflating drug prices and at the expense of pharmacies through low reimbursement and spread pricing.
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For pharmacists, PBM reform can seem like a daunting challenge that they can have little impact on. This could not be further from the truth. Pharmacists’ voices can effect real change and can help secure the future of the profession. With pharmacies continuing to close their doors due to unsustainable business models compounded by PBM practices, now more than ever pharmacists are being called to take action to ensure that patients and pharmacies are treated with equity and fairness.
In July 2024, the Federal Trade Commission published an interim report on PBMs, including the impact they have on the cost of prescription drugs. It was found that 6 of the largest PBMs manage 95% of all prescriptions filled in the United States.1 The report concluded that PBMs have continuously profited by overcharging patients for medications and influencing where the patient can obtain their prescriptions. It also highlighted the concept of vertical integration, a business strategy involving a company owning more than 1 stage of its supply chain. The report showed that the largest PBMs are also jointly owned or associated with the largest health insurers and pharmacies.1 PBMs use vertical integration to maintain control over which pharmacies the patient may use, show preference to businesses and pharmacies associated with the PBM, negotiate drug rebates, and negotiate unfair contract terms that particularly affect independent pharmacies.2
Amanda Rachidi, PharmD, RPh, is manager of clinical compliance and regulatory affairs at Rite Aid. In her role, she provides oversight and development of policies, procedures, and regulatory requirements for various federal, state, and third-party agencies to ensure that Rite Aid stores and pharmacies have the proper programs to operate at required industry standards.
Grassroots efforts have included providing federal and state legislatures with language about holding PBMs accountable for transparency in their practices. In 2024, NACDS hosted RxIMPACT Day on Capitol Hill, during which hundreds of pharmacy advocates came together to meet with legislators to advocate for a variety of issues, with the main issue being PBM reform.3
Unfortunately, even with all these strategies in play, meaningful reform was challenging in 2024 at the federal and state levels. Many of the proposed state bills were diminished and language about spread pricing was removed. At the end of 2024, Congress attempted to pass a federal funding bill as a short-term solution that included PBM reform. The bill ensured Medicaid would not be billed for more than what pharmacies are reimbursed and provided spread pricing data.4
However, before it was finalized, the incoming Trump administration halted the bill and Congress instead passed a bill that excluded these reforms.4
With that said, states are prioritizing PBM reform legislation. In 2024, 24 states passed 33 bills regulating PBMs.5 Idaho and Vermont passed bills prohibiting spread pricing, with House Bill (HB) 596 and Act No. 127, respectively.6 Other states, such as New Hampshire, New Mexico, and Virginia, passed similar bills requiring PBMs to report on the rebates they received.6 The latest state to pass PBM reform is Massachusetts, which passed Senate Bill (SB) 3012. This law takes effect on January 1, 2026, and requires the state to license PBMs and the PBMs to report data such as the number of rebates received.7 Although the bill in Massachusetts fell short of banning spread pricing, it indicates that PBM reform will be at the forefront of pharmacy issues in 2025.
Thus far in 2025, many states have introduced legislation for PBM reform. States such as Alabama (SB 93 and 99), Connecticut (HB 6814; SB 446, 758, and 821), Iowa (HB 213), Maryland (HB 321), Mississippi (HB 1123 and 1124), New Hampshire (SB 247), Oklahoma (SB 161), and Virginia (HB 2375 and SB 1311) have all introduced legislation related to PBM reform. Many of these bills are still in the early stages of the legislation process and face challenges such as bipartisanship before they can be enacted into law. However, bills such as Mississippi’s HB 1123 are dedicated to prohibiting spread pricing and have already passed in the state house. HB 1123 passed the Mississippi State Senate on March 12, 2025, and is currently going to conference to reach an agreement on proposed amendments.6,8
Pharmacists can not only advocate for these bills but also, in some cases, help review drafts and give comments or feedback on pending bills. In states that have not already introduced legislation for PBM reform, pharmacists can join state pharmacy advocates in pushing legislators to advocate for PBM reform and other issues that are important to the profession. The best way to get involved is by joining state pharmacy association groups that often have committees that volunteer their time, advocating for pharmacists and the profession at large. With pharmacists’ help, many of these vital reforms can be achieved.
