Alabama lawmakers advance regulations on pharmacy benefit managers
Two blocks from the Alabama Statehouse, a black wreath hung on the door of Adams Drugs — a symbol to draw attention the number of neighborhood pharmacies that have closed, or are in danger of closing, across the state.
Dozens of independent pharmacies have shuttered in Alabama over the last two years, according to the Alabama Independent Pharmacy Alliance. Pharmacists said that is, in part, because it can often cost more to dispense a drug than they are reimbursed by pharmacy benefit managers.
'We're losing almost one drugstore per week going out of business because they are paid such a small amount of money from the PBM industry to fill prescriptions for their patients at their drugstore,' Sen. Billy Beasley, a Democratic senator and retired pharmacist, said.
Alabama is one of several states considering new regulations on pharmacy benefit managers, the middlemen between health insurance companies, drug companies and pharmacies. The Alabama Senate voted 32-0 Thursday to advance legislation to require minimum reimbursement rates to community pharmacists. The bill now moves to the Alabama House of Representatives.
Legislation seeking regulations on the benefit managers have also been proposed in Mississippi, Arkansas and other states.
Pharmacy benefit managers leverage purchasing power with drug companies with the goal of driving down drug costs for consumers. However, independent pharmacists say the business practices of benefit managers cause them to lose money on about 20% of prescriptions.
'The biggest issue is we're not getting paid what it actually cost to fill a prescription, including labor,' Trent McLemore, a pharmacist with Star Discount Pharmacy.
The Alabama bill would require that PBMs reimburse community pharmacies at the Alabama Medicaid Agency reimbursement rate. It would also prohibit the practice of 'spread pricing' where a benefits manager charges health plans more for drugs than they pay pharmacies.
Groups opposed to the bill have said it would effectively put a new $10.64 fee on prescriptions under the requirement to match state Medicaid rates, which include a $10.64 dispensing fee. That fee, they argued, will eventually get passed down to consumers and businesses.
Helena Duncan, president of the Business Council of Alabama, told a legislative committee on Wednesday that small businesses, which might already be struggling to provide insurance to their workers, will have to either absorb the increased cost or pass it along to employees through premium increases.
'Shifting the financial burdens from pharmacies to the Alabama employers is fundamentally unfair,' Duncan told a legislative committee on Wednesday.
Republican Sen. Andrew Jones, a cosponsor of the bill, said Thursday said other states have seen drug prices go down. Jones said it is important to protect neighborhood pharmacies because they play a vital role in communities.
'You are not going to get a big box store to open in the middle of the night to get you the medication you need,' Jones said.
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Nationwide protests loom over Trump's upcoming military parade
WASHINGTON — Donald Trump is getting the parade he wanted showcasing America's military power — but he'll also be getting mass protests exposing the nation's partisan divisions. The tanks and artillery launchers rolling through Washington on Saturday will honor the Army's 250 th anniversary, which falls on the day Trump turns 79. About 7,000 soldiers will march. Hundreds of thousands of people are expected to line up along Constitution Avenue on the co-birthdays and cheer. Trump is set to watch the spectacle from a viewing stand south of the White House. But in Washington and in all 50 states, organizers will be staging protests that could dwarf the parade in size. A coalition of pro-democracy, labor and liberal activists is arranging a full day of counterprogramming to make the case that Trump is hijacking the Army celebration to venerate himself. 'The goal here is to deprive Trump of what he wants in this moment, which is a story about him being the all-powerful political figure of our time, and instead create a contrast with normal, everyday people demonstrating that power in this country still resides with the people,' said Ezra Levin, a co-founder of the progressive group Indivisible, who is helping organize what participants have dubbed a nationwide 'No Kings' demonstration. If past protests are a guide, the participants could number in the millions, he said. A total of 1,800 rallies are expected, with events in each congressional district, he added. Another group called Women's March is also arranging protests to coincide with the parade, with a theme of 'Kick Out the Clowns.' Organizers expect up to 5,000 people to participate in Madison, Wisconsin, alone, said Tamika Middleton, chief political and strategy officer of Women's March. 'Nothing feels more absurd than the idea of this president having a massive military parade on his birthday,' she said. "It feels surreal for many of us.' NBC News reached out to the White House for comment. On Tuesday, Rand Paul of Kentucky became the first Senate Republican to criticize the parade, citing the imagery. Showing off lethal hardware is something other countries do, not the United States, he said. 'I wouldn't have done it," Paul told reporters. He added that "we were always different than the images you saw in the Soviet Union and North Korea. We were proud not to be that." Trump isn't deterred. Speaking in the Oval Office on Tuesday, he warned that protesters this weekend will face " very big force." He didn't distinguish between those who demonstrate peacefully or violently. "And I haven't even heard about a protest," Trump added, "but you know, this is people that hate our country. But they will be met with very heavy force." (At a news briefing this week, a Secret Service official said thousands of agents and officers will be on hand to provide security.) The parade is happening at a fraught moment when Trump has drawn the military — among the nation's most trusted institutions — into a tense standoff in Los Angeles over his aggressive efforts to deport people living in the United States illegally. The Trump administration this week activated about 700 Marines to help quell demonstrations over his immigration enforcement methods, despite warnings from California officials that he is inflaming the situation. The military's main purpose is to fight and win foreign wars, and it has largely retained its reputation as an apolitical body carrying out a national mission. Only in rare instances has the nation held military parades: The last one took place 34 years ago after the United States defeated Iraq in the first Gulf War. Saturday will open with a festival on the National Mall. Soldiers will be on hand to meet people and take part in special military demonstrations. The parade will start at 6:30 p.m. ET and follow Constitution Avenue from near the Lincoln Memorial to the Ellipse south of the White House. Workers have been laying down steel plates to protect the roads from the heavy tanks. Bradley Fighting Vehicles will also be on display, while dozens of helicopters will take part in a flyover. At the Senate Armed Services hearing last Thursday, Army Secretary Daniel Driscoll put the cost at $25 million to $40 million. Driscoll justified the expense as a 'once-in-a-lifetime opportunity to fill up our recruiting pipeline with young Americans.' 'We have the greatest missiles in the world. We have the greatest submarines in the world. We have the greatest Army tanks in the world. We have the greatest weapons in the world. And we're going to celebrate it,' he said in an interview with "Meet the Press." Some military experts echoed that sentiment, seeing merit in an event that gives Americans a chance to thank their soldiers and see them up close. 'Only 9% of young Americans have an inclination toward military service,' said Kori Schake, who has worked at both the Defense Department and the White House National Security Council. 'And so, exposing more Americans to our Army, where kids can talk to soldiers about their experience, is good for the country.' Others said the money is being wasted. A better idea would be to restore programs serving veterans or rehiring some of those who lost their jobs in the Trump administration's effort to shrink the government workforce, some lawmakers and veterans groups said. Department of Government Efficiency cuts have fallen heavily on veterans, who make up a disproportionate share of the federal workforce. Meanwhile, the Veterans Affairs Department cut a program that provides mortgage assistance to veterans so they don't face foreclosure on their homes. The mortgage program 'helped tens of thousands of veterans stay in their homes. And they want to spend $50 million on a parade?' said Chris Purdy, who heads the Chamberlain Network, a pro-veterans group. 'It really shows this is about an individual's pride and not the nation's pride.' Rep. Adam Smith, D-Wash., a member of the House Armed Services Committee, criticized the parade's price tag in an interview. "The military is being required to spend resources and time on this, instead of training and preparing to meet the national security needs of the country," he said, adding, 'It's a horrible idea." Trump has long championed a military parade. In 2017, he attended the Bastille Day ceremony in Paris with French President Emmanuel Macron and got a firsthand look as tanks rumbled past the reviewing stand. The trip left an impression. After he returned to the White House, Trump spoke often about holding a similar parade at home, a former White House official said. Aides delayed and diverted him, mentioning the potential cost and telling him the United States didn't make a point of flaunting its hardware, the person said. 'Certainly, the French do it a lot and the North Koreans do it a lot and the Russians, but we don't really tend to do those things,' the former official said, speaking on condition of anonymity. 'He brought it up quite a bit,' the person continued, adding that in Trump's view, the Bastille Day celebration was 'in honor of Macron.' 'And he wanted that.' In his Oval Office remarks, Trump didn't mention the parade in the context of his birthday. He noted instead that the day is Flag Day. "We're going to have a fantastic June 14th parade, Flag Day," he said. "It's going to be an amazing day. We have tanks, we have planes, we have all sorts of things. And I think it's going to be great. We're going to celebrate our country for a change." Whether the day comes off as a tribute to the Army or to Trump hinges on how Trump behaves in the moment, analysts said. 'The degree to which this is a violation of norms depends in part on what the president says and does on the margins of this event,' said Peter Feaver, a Duke University political science professor who has written about the military's relationship with political leaders. In the run-up to the parade, Trump is capitalizing on the Army's milestone birthday in partisan terms. Speaking Tuesday at Fort Bragg, North Carolina, he took aim at various Democratic foes, including the last commander in chief, Joe Biden. He invoked Los Angeles Mayor Karen Bass, another Democrat, eliciting boos from the audience. Mentioning Minnesota Gov. Tim Walz, the Democratic vice presidential nominee last year, Trump said: "I think he's running for president, but he's a radical lunatic." Linking the military to the sitting president's birthday and sending it into the streets to confront fellow Americans risk tarnishing its credibility while pushing the country away from its democratic roots, Trump's critics warn. 'Displays of hardware, whether its tanks or Stryker vehicles, is more characteristic of totalitarian militaristic states like North Korea or Russia,' said Sen. Richard Blumenthal, D-Conn., a member of the Senate Armed Services Committee, who questioned the event's cost at a recent hearing with Army leaders. 'And they are used in part to glorify the dictator in those countries. This parade falls on President Trump's birthday and is as much a celebration of his birthday and him — at least it's designed to be — as it is our Army.'
NBC News
an hour ago
- NBC News
In Michigan, two Democrats are generating 2028 buzz
LANSING, Mich. — As she spoke Friday night in the high school gymnasium where Magic Johnson starred as a prep basketball player, Sen. Elissa Slotkin, D-Mich., reached for a football analogy while wrestling with the existential questions facing the Democratic Party. 'We know the Lions are going to the Super Bowl this year because they have a good defense and a good offense, right?' Slotkin, referring to Detroit's NFL team, told an audience of roughly 400 people at a town hall forum. 'So we have to be able to do both,' Slotkin added. 'We have a strong defense, but then you've got to have a vision, an alternative vision, to what is being provided to us every day. And that is the charge of the next generation of leaders in the Democratic Party.' Slotkin narrowly won her Senate seat last year, prevailing in a competitive state that backed Donald Trump for president. Almost instantly, given her against-the-current victory and Midwest perch, Slotkin became a go-to voice for a party struggling with its identity. She delivered the Democratic response to Trump's joint address to Congress in March. She also has thrown herself into advocating for a robust takedown of the president's agenda. 'I wrote a war plan,' the former CIA analyst and Pentagon aide told her audience here last week, 'of how to contain and defeat Trump — a 17-page PowerPoint.' The town hall put Slotkin in her old congressional district, but the content was consistent with a message that she has been testing nationally. And by advancing her 'alternative vision,' Slotkin is establishing herself as another Democratic officeholder in Michigan who could emerge as a White House contender in 2028, along with Gov. Gretchen Whitmer. Whitmer, a subject of presidential speculation for years, remains popular with voters in a state that was placed near the front of last year's primary calendar. Unlike Slotkin, she has taken a less confrontational approach toward Trump in his second term. Those familiar with Slotkin's rise stress that her Senate campaign should not be viewed as some grand plan to quickly build a higher profile and set up a run for president. But a Democratic strategist who has worked on Michigan races believes that it's something she will at least consider. 'The way she thinks of it is, this party is on the precipice of full-on collapse,' said this person, who like others was granted anonymity to talk about a fluid situation and discuss sensitive intraparty dynamics ahead of 2028. 'Circumstances have just sort of pushed her into this.' Slotkin rolled her eyes and briskly sidestepped when asked in an interview if people have been encouraging her to consider running for president in 2028. 'I'm about to go out in front of 1,000 people who think that they're going to lose their health care,' she told NBC News before her town hall at Everett High School. 'I am focused on, literally, saving them from losing their health care and their food. And I get it. I know it's a good parlor conversation. It's just, honest to God, not where my head is focused right now. It's just not.' Whitmer's way Whitmer was a finalist to be Joe Biden's vice presidential running mate in 2020, having positioned herself at the time as a prominent foil for Trump and a critic of his pandemic management. Whitmer also was on a short list of Democratic governors and senators who were seen as potential replacements for Biden on the ticket last year before then-Vice President Kamala Harris sewed up the nomination. Spokespeople for Whitmer did not respond to requests to interview the governor for this article. Two Democratic operatives who have worked with her said it is unclear to them what her intentions are for 2028 and would not be surprised if she were to pass on a run. 'I think it's a huge open question,' one of the operatives said. 'What people who don't know her miss is that she's a super-regular person who likes hanging out at the lake and drinking beer and hanging out with her dogs and husband.' Although the term-limited Whitmer has not made definitive plans, many of her recent moves as governor have been viewed through the prism of national politics. She has made public overtures to Trump, meeting with him at the White House and working with him on issues important to Michigan. Whitmer's way has been rewarded on one level. Trump announced a new fighter jet mission for an endangered air base in her state and committed his administration's support to combat Asian carp, a Great Lakes nuisance. On the latter issue, the White House even took a shot at Democratic Illinois Gov. JB Pritzker, a potential Whitmer primary rival in 2028 whom the Trump administration characterized as a hindrance to mitigating the ecological impact of the invasive fish. But Whitmer's courtship also has put her crosswise with other Democrats who find her too accommodating of Trump. After one of her White House meetings in April, Whitmer joined Trump for a photo opportunity in the Oval Office, where the president announced investigations of two political adversaries and repeated his debunked claim that the 2020 election was stolen from him. Adding to Whitmer's political troubles that day was a New York Times photographer who documented the governor — who later acknowledged she did not want her picture taken there — hiding her face behind blue folders. Whitmer's team has taken comfort in internal and independent polling since then that has shown that a majority of Michigan voters approve of her job performance as governor. 'From her perspective, I think it's, 'I'm going to do as good a job as I can for the people in my state, and the political benefits will follow,' as opposed to others who are taking different approaches by showing up in New Hampshire and South Carolina,' two states typically at the front of the primary calendar, said another operative who has worked with Whitmer. 'Are they as focused on their states as they should be? Will they have a set of accomplishments?' In a presidential primary debate, this person added, 'all she has to do is throw in a couple of places where she's held Trump's feet to the fire and stood up to him. Yeah, she took some s---, but she's positioned herself well to make a pretty compelling argument that she got some really important stuff for her state that at the end of the day made her a great governor.' Michigan Democratic Party Chairman Curtis Hertel, who served in the Legislature during Whitmer's first term as governor, praised her for working across the aisle but also for championing new gun-safety laws and a repeal of the state's anti-union 'right-to-work' law. 'Too often we find labels and differences in places where there aren't,' Hertel said in an interview. 'It's incredibly important that we're pushing back and fighting back and all those things. That doesn't mean there aren't places of agreement where we can work with each other. That's part of being a successful public servant. … So I don't think it's a binary choice, and I think that our leaders in Michigan understand that, and I think that's how they're behaving.' Slotkin calling 'balls and strikes' Slotkin has used her bully pulpit as a newly elected senator to push back on Trump more. 'I think for me,' she said in the interview, reaching for another sports metaphor, 'it's just call balls and strikes on what he's proposing and what it's going to do to your business, your life, your family. You don't have to overhype what's happening, but don't underhype it, either.' Slotkin also has a calling card Whitmer doesn't: She has twice won tough elections — her first House re-election bid in 2020, and last year's Senate race — with Trump on the top of the ticket. (A third Michigan Democrat who could run in 2028, former Transportation Secretary Pete Buttigieg, lives in the state but has never won an election there and is associated more with Indiana, where he was the mayor of South Bend.) 'Gretchen,' said the strategist who has worked on Michigan races, 'has only had to run statewide in two cycles good for Democrats, and never on the ballot the same year as Trump. It's a completely different dynamic.' One of the operatives who has worked with Whitmer characterized the differences between her and Slotkin as minor nuances. 'The No. 1 similarity, which is probably more important than all of those smaller discrepancies, is that they're tough women,' this person added. During Friday's town hall, during which members of a heavily Democratic audience read aloud questions they had submitted in advance, Slotkin shared a stage with Hertel and Rep. Kristen McDonald Rivet, who won her seat last year in a competitive, neighboring district. Slotkin's old district, now represented by Republican Tom Barrett, is the type of place where they are hoping to rally discouraged Democrats. Questions ranged from concerns about spending cuts and Trump's massive domestic policy bill to a fear that the president could declare martial law to postpone future elections — an unsubstantiated theory percolating on the political left. Slotkin validated their worries with calls to action. 'The president has made comments that are real close to martial law,' she said. 'He's talked about sending the National Guard into our cities. We need to listen when he says things.' The next day, Trump deployed the National Guard to the Los Angeles area to counter protests against immigration raids, ignoring the wishes of California Gov. Gavin Newsom, a Democrat. Slotkin also pressed the audience to engage Republicans, noting how she invited her township supervisor, a Republican, to join her at Trump's inauguration in January. 'We've got to have these conversations, not just with them, but with those folks who just kind of can't stand politics either way,' Slotkin said. 'It's hard to like politics right now. Most of you probably don't like it. You just do it because you love your country.'
NBC News
an hour ago
- NBC News
Democratic governors seek to roll back state-funded health care for undocumented immigrants
A trio of states with Democratic governors viewed as potential 2028 presidential candidates have taken steps in recent weeks to freeze or cut government-funded health care coverage for undocumented immigrants. Democratic Govs. Gavin Newsom of California, JB Pritzker of Illinois and Tim Walz of Minnesota have largely attributed the proposals to budget shortfalls stemming from original plans to expand health care to immigrants without legal status. But the moves also occur against the backdrop of broader debate within the Democratic Party over how to handle immigration, an issue that dragged it down in the last election and that President Donald Trump and the GOP have continued to try to capitalize on. The plans, which would scale back health care coverage for undocumented immigrants in the three Democratic-led states just years after it was expanded, have angered progressives and immigrant advocacy groups, who warn the party risks alienating its base — particularly as protests against Trump's deportation plans break out around the country. The latest development came in Minnesota on Tuesday, after both chambers of the Legislature passed a bill to end state-funded health care for undocumented adults. The bipartisan effort advanced through the Republican-controlled House and the Democratic-controlled Senate as part of attempts to balance the state budget. It now goes to Walz, who has said he'll sign it. The bill would end undocumented adults' eligibility for MinnesotaCare — the state-funded health insurance program for low-income residents — effectively reversing one of the signature policy wins Walz secured during a landmark legislative session in 2023, when Democrats were in full control of state government. Undocumented children would remain eligible to enroll in the program under the legislation. In California, Newsom unveiled a budget plan last month that would cut back on health care benefits for undocumented immigrants — a stark reversal from his promises of universal health care for all the state's residents, regardless of their immigration status. Newsom's plan in his 2025-26 budget has called for freezing enrollment for undocumented adults to receive the full scope of the state's Medicaid program, known as Medi-Cal. Newsom's office has said the changes would apply only to new applicants over age 19, that existing enrollees wouldn't be kicked off their plans and that the freeze, which would begin next year, wouldn't apply to people enrolled in limited plans. Newsom's proposed changes also included a new $100 monthly premium for adults 19 and older with 'unsatisfactory immigration status' beginning in 2027. His expansion of Medi-Cal has cost far more than his administration anticipated. Newsom has said the changes will help to balance the state's budget, which has run a multibillion-dollar shortfall that he has blamed on Trump's tariffs, as well as growing costs from higher enrollment in Medi-Cal. Meanwhile, Illinois remains on track by the end of the month to end a program — called Health Benefits for Immigrant Adults — that provides state-funded health care coverage for more than 30,000 low-income adults who are living in the state without documentation. Similarly, the program in Illinois was more expensive than expected when it was created in 2021. Pritzker's latest budget, which the Democratic-led Legislature passed last month, proposed eliminating it by July 1. While the moves would help those states recalibrate their budgets, a sweeping Trump-backed domestic policy bill moving through Congress proposes slashing Medicaid funding for states that provide health care coverage to undocumented immigrants. Trump also signed an executive order this year targeting undocumented immigrants' access to government assistance programs. In response to questions from NBC News, Newsom spokesperson Elana Ross reiterated his statement in his initial announcement of the changes last month that 'instead of rolling back the program — meaning cutting people off for basic care — we're capping it.' Pritzker's office said in an email that 'this year, passing a balanced budget required the difficult decision that reflects the reality of Trump and Republicans tanking our national economy and attempting to strip away healthcare.' A Walz spokesperson didn't respond to questions about Minnesota's plan, which was the result of a compromise after Republican lawmakers had pushed to end the entire MinnesotaCare program. 'No one got everything they wanted,' Walz said last month after he reached a tentative deal with Republicans on the budget, which was finalized in a special session this week. 'There were very difficult conversations about issues that were very dear to each of these caucuses. But at the end of the day, we were able to come to this agreement.' Blowback from the left Immigrant advocacy groups have panned the moves, saying they risk further imperiling the broader health care system, and blasted Democrats for succumbing to Trump's attacks. 'We urge state leaders to build on their progress, rather than placing the health of their residents at risk,' said Tanya Broder, the senior counsel for health and economic justice policy at the National Immigration Law Center. 'Particularly as extremist politicians scapegoat and target immigrants, we are counting on state officials to do the right thing and hold the line. 'As states increasingly have recognized, a community's health and well-being depend on ensuring that everyone has access to health care. Immigrants pay billions of dollars in federal, state and local taxes, yet many are excluded from critical health care programs,' she added. 'Terminating state coverage for immigrants will compromise our collective health, as well as the health care infrastructure that serves all of us.' Some progressives questioned whether the moves were part of a broader strategy by the three governors to move to the right on the broader issue of immigration, which polling has shown still remains one of Trump's strongest issues. They said they could face a backlash from their base by departing from positions on supporting immigrant communities and expanding health care. 'It really feeds into the conservative narrative that undocumented immigrants are a drain on our communities,' said Jennifer Driver, a senior director at the State Innovation Exchange, a progressive legislative policy group. 'This assumption that by moving more to the middle or to the right that you're going to recruit some people back — I think it's a miscalculation. 'The frustration that you're seeing in the Democratic base is due to this kind of this waffling, this kind of idea that 'OK, yes, we are progressive — but only in some moments,'' Driver added. Other strategists suggested it remained too early to gauge whether a broader shift was in play as governors and other lawmakers positioned themselves for potential 2028 White House bids, and they emphasized that the threats blue states face from Trump are serious. 'The Trump administration is squeezing the hell out of states,' said Jeff Blodgett, a Minnesota-based Democratic strategist who was a campaign manager for the late Sen. Paul Wellstone and the state director for both of Barack Obama's presidential campaigns. 'There's just a lot of concern about current and future budgets given what the federal government is doing to states.'
