More than a hundred local pharmacies walkout, asking for PBM reform in Alabama
The unprecedented walkout is meant to call attention to proposed state reforms that would increase how much independent pharmacies are paid.
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Neighborhood pharmacies are disappearing from communities across Alabama. Pharmacists say they are not being reimbursed as much as their corporate counterparts, and the profit gap is hitting them hard.
Change could come from the state legislature this year.
Two introduced bills would create reforms for pharmacy benefit managers (PBMs). PBMs are the intermediaries between pharmacies and insurance companies, and they negotiate how much the pharmacy makes when you pay for your prescription.
Chase Arrington, the owner of River City Pharmacy in Decatur, said many independent pharmacies are not making enough to survive.
'I think if something doesn't happen this legislative session, probably within a year or two there, there may not be any local pharmacies,' Arrington said.Arrington is asking state lawmakers to take on the system led by PBMs, who generally pay higher rates to corporate pharmacies. They are often affiliated with these pharmacies under the same company's ownership.
CVS Health is the largest PBM with 21% of the U.S. market, followed by Optum RX, which is owned by United Health Group. Blue Cross, owned by Prime Therapeutics, has 10% of the market.
'Patients are already being steered to corporate-owned pharmacies or mail order and a lot of times that's not even what they want to do, that they're kind of forced that way,' Arrington said.
Currently, PBMs can deny coverage for certain drugs at small pharmacies, and prescriptions are sometimes more expensive at a local drugstore than they would be at a large chain. Two Senate bills, SB 93 and SB 99, look to address these issues.
SB 99 would offer more regulatory power to the Department of Insurance so it could set benchmarks for reimbursement. Both bills would require PBMs to pay pharmacies for the cost of dispensing drugs, and they call for those payments to come from PBM profits, not from consumers.
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'The healthcare system in this country is broken,' Arrington said. 'We all know that we're worried that the cost for health care for patients is continuing to climb and pharmacies are closing in every week. We just feel like PBM reform is important this legislative session to keep our patients' access to care there.'
As a part of Tuesday's walkout, many local pharmacies are asking their customers to contact state lawmakers and tell them they support PBM reform.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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The proposed legislation Congress has been looking closely at PBM reform for several years, and a detailed bipartisan bill was removed from last December's stop-gap budget after Elon Musk tweeted that it was too long. Leading committees are now working to pass something similar. Indeed, two bills that passed Committee last year were reintroduced: The Prescription Pricing for the People Act directs the Federal Trade Commission to complete its ongoing study of PBM practices. The Pharmacy Benefit Manager (PBM) Transparency Act bans spread pricing, incentivizes PBMs to pass 100% of the rebates they receive to plan sponsors, encourages transparency, and requires annual reporting by PBMs of their pricing, reimbursement, and rebate practices. Other proposals go further, including the Patients Before Monopolies Act, which would ban PBMs and insurance companies from owning a pharmacy. The states have been busy as well, increasing their oversight of PBM practices through new legislation and reporting requirements. Unintended consequences of all of this are a concern for consultants and employers looking to control costs. In Colorado, Governor Polis signed HB 25-1094 into law in May. Effective in 2027, this law will regulate how PBMs can earn income, how they structure their formulary, and how they reimburse unaffiliated versus PBM-affiliated pharmacies, among other changes. Unfortunately, this new law won't apply to many large employer-sponsored healthcare programs. So large employers in Colorado are still left to design their own pharmacy strategy. Switching to a transparency-oriented PBM In recent years, more employers have switched their pharmacy programs to a new crop of PBMs who are unaffiliated with large insurers—including Navitus Health Solutions, Rightway Rx, Capital Rx, and SmithRx—and offer a more transparent business model. The advantages Pass-through pricing: Employers get the full benefit of network discounts and rebates, and instead of spread pricing, they pay a disclosed administrative fee per prescription. Fewer conflicts: The independent PBMs are less likely to have pharmacy operations or other business interests that differ from those of employers. Transparent disclosures: Employers get access to granular information about the pricing of each prescription rather than the opaque summaries provided by the large PBMs. Aggressive cost management: The independent PBMs emphasize lower net cost options in their formularies and have strict prior authorization requirements for more expensive drugs. The disadvantages Negotiating intermediaries: Since the upstart PBMs are small, many band together by using rebate aggregators, entities that negotiate lower prices with drug companies. But these negotiations have a downside: They can obscure the details of drug company rebates, especially since most of the aggregators are owned by the same insurance conglomerates that own the big PBMs. Potential disruption: Changing PBMs means employees must adjust to a new formulary, pharmacy network, and prior authorization procedures. Members may also object to the stricter utilization controls these companies use. Buying power: Smaller PBMs do not have the volume that the larger players do and are also unable to take on the risk of aggressive discount and rebate guarantees which can lead to a financial arrangement that appears to be less advantageous for employers. Renegotiating with your existing PBM Many companies that have investigated using a more transparent PBM ultimately decide that the advantages of sticking with a large provider outweigh the frustrations and potential conflicts. They are: Convenience: Dealing with one company that provides medical benefits, pharmacy benefits, and mail-order pharmacy service can be easier for employers and plan members alike. Lower effective prices: Some employers find that the greater bargaining clout of the large PBMs delivers good value even if the mechanics of their arrangements remain murky. Increased transparency efforts: Faced with the prospect of increased regulation, CVS Caremark, Express Scripts, and OptumRX have all announced programs that disclose more information about pricing and pass more of their rebates to employers. As they are just being instituted, their real-world impact remains to be seen. In any case, employers and their advisors can't afford to wait to scrutinize their PBM's business practices and press for more advantageous contracts. The time is now to: Look at the fine print: A typical PBM contract may specify high-level drug discounts, rebates, and dispensing fees. Dig deeper, and you can find exclusions and key definitions, such as what is a 'specialty drug.' Press for full pass-through of rebates: Work through every category and proposed exception to insist that rebates for all drugs go to the employer. Ask about conflicts: How does the PBM interact with its affiliated pharmacies? Are reimbursements different than those for independent pharmacies? Are the dispensed drugs made by brands it owns? Check its approach to cost control: What is its philosophy for adding drugs to its formulary? How does it generate prior authorization guidelines for drugs with high rebates? What percent of authorization requests are approved? Audit performance: At the end of a contract, demand a detailed itemization of all claims to ensure that the PBM has met its commitments. If it hasn't, fight for a financial adjustment. Whether your company decides to find a new PBM or renegotiate its deal with the current provider, there are a lot of details to consider. An experienced broker or consultant will help you sort through those complex contracts designed to confuse. And if Washington does end up passing PBM reform, that advisor will also be able to adapt your plan to take maximum advantage of the new rules. To learn more, contact Chris Mast, an actuary and benefits consultant with Alliant Employee Benefits in Greenwood Village, CO. Mast has worked with employers across Colorado and the US for more than 20 years. He can be reached at Alliant's Pharmacy team is made up of industry experts, pharmacists, and data specialists who provide marketplace perspective and insights, vendor capabilities, and practical knowledge to secure the best pricing and contract arrangements. Our buying power and partnerships enable us to support your benefits strategy, pharmacy program, and cost management throughout the entire program lifecycle. Learn more about Alliant at
