Pharmacy Benefit Managers (PBMs) were originally designed to help manage prescription drug benefits and negotiate better prices. However, over time, their role has expanded – often in ways that raise serious concerns about transparency, competition, and patient outcomes. A lack of oversight has allowed the largest PBMs to dominate the market, and patients are increasingly feeling the consequences.
The Federal Trade Commission and other entities have launched investigations into PBM business practices, including the way they influence drug formularies, reimbursement rates to pharmacies, and the use of mail-order networks they own. These practices can result in delayed treatments, increased costs, and reduced access to care – especially for individuals with chronic illnesses and for those in rural or underserved communities.
Independent pharmacies in New York are especially vulnerable. Many are operating under growing financial pressure due to unpredictable and often inadequate reimbursement rates, fees that are applied retroactively, and restrictions that limit where prescriptions can be filled. As a result, some pharmacies are being forced to scale back services or close altogether – leaving patients without trusted, accessible healthcare providers.
Fortunately, solutions are on the table. Representative Nicole Malliotakis of New York has shown consistent leadership on this issue by cosponsoring the PBM Reform Act of 2025 (H.R.4377). This bipartisan legislation aims to increase transparency and accountability in how PBMs operate. Among its provisions, it would prohibit spread pricing in Medicaid, delink PBM compensation from the price of medications in Medicare, and provide regulatory tools to better oversee this part of the pharmaceutical supply chain.
This is a commonsense step toward restoring balance in the prescription drug system. By addressing practices that contribute to rising costs and barriers to care, the PBM Reform Act would help ensure that patients can access the medications they need – and that community pharmacies can continue serving them.
We urge the rest of New York’s congressional delegation to join Rep. Malliotakis in advancing this critical legislation. Federal reform is essential to protecting patients, supporting small businesses, and restoring trust in our healthcare system.
Pharmacists across the state are ready to work with lawmakers on solutions that benefit the public good. It’s time to bring greater fairness, accountability, and patient focus back into prescription drug coverage.
