Recent legislation in Alabama was designed to rein in the unchecked power of pharmacy benefit managers (PBMs), but patients and independent pharmacies across the state are still paying the price due to deceptive PBM influences.
PBMs claim they manage prescription drug benefits and lower costs. Instead, they’ve evolved into powerful, profit-driven middlemen that insert themselves between patients, pharmacies and drug manufacturers. Today, they operate with little transparency, dictate which medications patients can access, and determine how much pharmacies are paid – often significantly below cost.
Pharmacists feel an innate responsibility to take care of their patients. So much so, they often provide care despite financial loss. If you have ever been told, “We can’t get that drug,” or “You must use a special pharmacy,” your local pharmacist was likely under siege by a gag clause or other unfair PBM mandate.
A new coalition, the Alabama Independent Pharmacy Alliance (AIPA), is leading the grassroots charge to fight back. Their work this session pushed lawmakers to pass legislation aimed at curbing PBM abuses. This landmark reform was a huge win for patients and small businesses; however, the fight is far from over.
SB252 was signed into law on April 15, 2025. Unfortunately, more than 90 days later, PBMs are still skirting regulations and continuing their profit-driven practices. Alabama’s independent pharmacies – often the only source of medications in rural communities – are still closing their doors. Others are barely surviving with reimbursement rates so low they can’t afford to keep life-saving medications on their shelves. The law is supposed to bring higher payments to pharmacies on Oct. 1, but with PBMs already noncompliant to the early provisions of SB252, there is concern these middlemen will not submit to what lawmakers have enacted.
This isn’t a partisan issue. It’s a matter of access, fairness and common sense.
PBMs decide which medications are “preferred,” even when more affordable or more effective alternatives exist. They steer patients away from local pharmacies and toward mail-order companies they own. They retroactively claw back payments from pharmacies weeks or months after prescriptions are filled. These practices would be unthinkable in almost any other industry.
These tactics don’t just hurt small businesses; they harm patients. When a local pharmacy closes, the next closest one might be 20 or 30 miles away. Elderly patients, those without transportation, or families managing chronic illnesses are left with fewer options, longer waits and rising out-of-pocket costs.
If you think this sounds like a monopoly, you are not wrong. Three PBMs, CVS Caremark, Cigna (Express Scripts), and UnitedHealth (Optum), control over 80% of the market. UnitedHealth is third on “The Fortune 500,” and the others are in the top 16. Their practices directly affect what medications are available, how much they cost, and whether your local pharmacy can afford to stay open. In our own state, Blue Cross of Alabama controls approximately 86% of the commercial prescription drug market.
So where do we go from here?
First, we must tighten enforcement of the current PBM laws. Regulators must be empowered and willing to hold PBMs accountable. From conversations with AIPA, it appears the Department of Insurance is gearing up to do so. A strong stance from the attorney general is now needed. What is his position? The inquiry has been made and is awaiting a reply.
Second, Alabama citizens should support and strengthen groups like AIPA which continue to fight this battle every day. AIPA takes zero salaries and implements transparent practices. This isn’t a corporate lobbying group. It’s a coalition of everyday pharmacists and business owners who have banded together out of necessity to protect their patients and their communities.
Third, we need more transparency. PBMs should be required to disclose how much they make and who’s profiting from their decisions. PBMs must be held accountable for how their actions impact pharmacies and patients alike.
At a time when healthcare costs are skyrocketing and rural healthcare access is shrinking, we can’t afford to let profit-driven middlemen call the shots. PBMs have spent millions convincing the public they save us money, but if you ask the hundreds of independent pharmacists in Alabama – or the patients they serve – you’ll hear a different story: PBMs are making healthcare worse, not better.
The movement that began with AIPA has shown what’s possible when regular people stand up to entrenched power. But the job isn’t finished. With continued pressure from citizens and lawmakers who are not fooled by corporate spin, Alabama can lead the way in restoring fairness, access and integrity to the pharmacy system.
B.J. Jones is a graduate of Samford University and owns 2 independent pharmacies in Northeast Alabama. He is one of the founders of AIPA and a member of the AIPA Executive Board. He has practiced pharmacy for over 20 years and advocates for healthcare, small business, and small government.
The views and opinions expressed here are those of the author and do not necessarily reflect the policy or position of 1819 News. To comment, please send an email with your name and contact information to [email protected].
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