Jennifer Riley, executive director of Patients Come First in Pennsylvania, said that state policymakers should prioritize reforms targeting pharmacy benefit managers (PBMs), pharmacy closures, medical advertising practices, and oversight of the federal 340B drug pricing program, arguing these issues directly affect patient access, costs, and care decisions.
In an op-ed, Riley said PBMs play a central but often opaque role in the prescription drug supply chain, influencing which medications are covered, where prescriptions can be filled, and how pharmacies are reimbursed.
“Pharmacy benefit managers (PBMs) play a central but often invisible role in the prescription drug supply chain, influencing which medications are covered, where patients can fill prescriptions, and how much pharmacies are reimbursed. Their market power and lack of transparency have been linked to rising costs and a growing number of pharmacy closures. Pharmacy access is no longer a niche issue. It is a core access and affordability issue,” Riley said, according to PennLive.
Pennsylvania has seen significant changes in its pharmacy network in recent years. The state lost about 1,100 licensed pharmacies between early 2020 and November 2025, including roughly 500 Rite Aid locations, due in part to PBM reimbursement rates and network restrictions that critics say have made it difficult for independent pharmacies to remain open, according to Spotlight PA.
In response, state lawmakers enacted Act 77, which expanded oversight of PBMs by requiring registration, annual network adequacy reporting, and new transparency measures, along with regulations addressing patient steering and reimbursement practices tied to pharmacy access and drug costs, according to the Pennsylvania Department of Insurance.
Riley also raised concerns about the federal 340B Drug Pricing Program, saying patients often do not see savings at the pharmacy counter despite hospital participation in the program.
“In Pennsylvania, more than 70 hospitals participate in 340B, yet patients often see no reduction in out-of-pocket costs at the pharmacy counter. In fact, available data show these hospitals generate roughly 7.1 times more in 340B-related revenue than they spend on charity care,” she added.
The 340B program allows eligible hospitals and clinics to purchase outpatient drugs at or below federally defined ceiling prices with the goal of stretching resources for safety-net care. However, debate continues over whether savings consistently reach patients, according to the Health Resources & Services Administration.
Pennsylvania’s 340B network includes 67 participating hospitals with more than 6,700 contract pharmacy arrangements. Charity care averages about 1 percent of total operating costs at these hospitals, while assets increased about 20% from 2014 to 2022 even as charity care declined by 36% during the same period, according to PhRMA.
Riley said PBM reform, oversight of medical advertising, and accountability in the 340B program are all central to patient access and affordability.
“PBM reform, responsible oversight of legal advertising, and accountability in the 340B program are equally central to the everyday healthcare experience of Pennsylvanians,” she said.
Patients Come First describes itself as a patient advocacy organization focused on opposing policies it says create barriers to care and delay innovation. Riley is described by the group as a lifelong Pennsylvanian with two decades of advocacy experience.
