States Attempting PBM Legislation
Most states have taken some PBM action (licensing, transparency, anti-clawback rules), but only a minority passed the most aggressive reforms (ownership bans, delinking compensation, or guaranteed full rebate pass-through) by mid-2025 — and several states saw promising bills stall or be blocked by courts. Legal risk (ERISA/commerce clause), industry lobbying, cost/access trade-offs, and political calculus […]
Cost Sharing? Or Cost Shifting in Disguise…
Despite numerous existing policies and regulations in place, certain groups continue to operate as if they are untouchable… Pharmacy Benefit Managers (PBMs) and their associated dispensing pharmacies (CVS/Caremark, Evernorth/Cigna/Express Scripts, Humana, OptumRX, Prime Therapeutics to name a few) have been documented in multiple settlements, judgements, and allegations that have accounted for billions of dollars in […]
Pharmacy Pains – Praying for Gains
Local pharmacies are part of our community — they give medicine, vaccines, and help when people are sick. PBM practices that hide how money moves and pay pharmacies too little are closing these stores. We ask lawmakers to stop unfair PBM practices now so pharmacies and patients are protected. The problem (plain language) Pharmacies are […]
OptumRX Continues The Game
Another perfect example of PBM attempted overreach: changing a contract requirement in the middle of the contract term, creating hostile dispensing environment(s) for retail dispensing pharmacies, potentially conflicting already existing multiple state & federal laws, creating anticompetitive scenarios – with the only potential intent to hold pharmacies hostage for funds, with zero recourse outside of […]
Power to Choose: How State-Level Health Regulations Are Restoring Patient Choice — and Raising Community Health
Across the country, states are quietly reshaping the rules that govern where patients get their medicines, who can treat them remotely, and how health dollars flow between insurers, pharmacy benefit managers (PBMs), providers and pharmacies. Those changes aren’t just regulatory bookkeeping. They’re a practical rebalancing of power — away from opaque middlemen and toward patients, […]
The Silent Collapse of America’s Pharmacies — And Why Our Health Depends on Saving Them
The Silent Collapse of America’s Pharmacies — And Why Our Health Depends on Saving Them If a hospital shut down in your town, it would make headlines. If the last primary-care clinic closed, local leaders would hold emergency meetings. But when a pharmacy closes — even though pharmacies provide more day-to-day health care than almost […]
The Price of Clarity: West Virginia’s PBM Reforms, Community Health, and Patients’ Right to Choose
West Virginia is not always the first state that comes to mind when the national conversation turns to health-care innovation. Yet in the ongoing battle to expose the hidden inner workings of pharmacy benefit managers (PBMs)—the powerful intermediaries who negotiate drug prices and steer patients through pharmacy networks—West Virginia has emerged as a rare leader. […]
Hesitancy with Reform: Why it Happens
Even when legislators agree that PBM practices deserve scrutiny, many become cautious when reform proposals appear likely to cause immediate cost spikes, network instability, or pushback from large insurers and PBMs. Because most PBM reforms fundamentally change how prescription drug pricing flows through the healthcare system, the short-term effects can be unpredictable — and opponents […]
Priorities and Partisanship: Why Many States Stall or Scale Down PBM Reform
Even though pharmacy benefit manager (PBM) reforms are broadly popular with voters, pharmacists, and even many patient groups, the politics of large-scale reform are far more complicated. In many states, PBM legislation does not fail because lawmakers oppose patient choice — it fails because it competes with dozens of other legislative pressures and navigates partisan […]
Dire Straights from Missouri
Missouri leads most trends in healthcare shortages, at an ever-growing rate. Numerous factors are at play, and need to be addressed for patient safety.