Political commentator Matt Wallace expressed concerns regarding pharmacy benefit managers (PBMs), describing them as dominant middlemen whose consolidation and pricing practices are inflating family costs and limiting access, particularly in rural areas, an issue attracting attention in Pennsylvania. He urged bipartisan action to address PBM abuses.
“Pharmacy Benefit Managers are third-party companies who ‘manage’ prescription drug benefits, acting as “middlemen,” said Wallace. “Right now, rural America is getting crushed by the health insurance-PBM cartel. The ‘Big Three’ PBMs now control nearly 80% of the drug market, and PBM-owned pharmacies dominate 75% of mail-order, as well as 68% of specialty drugs, with markups over 1,000% in some cases. Families are paying more while access has nearly disappeared. This should be a bipartisan issue that Democrats and Republicans come together to work on.”
According to a press release, there are significant risks to rural access due to PBM reimbursement practices that fall below cost. Senator Shelley Moore Capito highlighted the closure of over 300 independent pharmacies in 2023, with the trend worsening in 2024. She noted that PBMs reimburse “significantly less than it costs the pharmacy to even purchase the drug,” placing a strain on small family businesses and rural communities.
Federal scrutiny has brought attention to the concentration of PBMs. The Federal Trade Commission’s (FTC) inquiry into PBMs reports that decades of mergers have resulted in the three largest PBMs managing “nearly 80 percent of all prescriptions filled in the United States.” This dominance provides vertically integrated PBMs with substantial control over formularies, reimbursement, and steering—key factors that can disadvantage independent pharmacies and plan sponsors.
The FTC’s interim report from January 14, 2025, found that the Big Three PBMs generated more than $7.3 billion between 2017 and 2022 by marking up specialty generics—often by hundreds or even thousands of percent—on drugs for cancer, HIV, and other serious conditions. These findings follow a July analysis revealing nearly $1.6 billion generated from just two oncology generics through affiliated-pharmacy steering.
Pennsylvania’s Act 77 (signed July 17, 2024) explicitly expands the Insurance Department’s authority over PBMs, changes PBM and auditing-entity registration, and adds requirements affecting PBM contracting and auditing. The law reflects lawmakers’ concern that PBM business practices were harming pharmacies and patients and needed tighter oversight.
Wallace is an American social-media personality and entrepreneur who runs the “Final Stand” brand across platforms, producing videos, livestreams, and frequent updates for a large online audience. On his site, he describes creating “high-value content” for viewers on multiple channels and notes personal roots in Atlanta, plus interests that include travel and community engagement—positioning him as a broad pop-culture and news commentator.
