Keystone Today

Attorney General Dave Sunday sent a letter to congressional leadership asking them to pass a bill that would prohibit pharmacy benefit managers (PBMs) from owning or operating pharmacies. 

The letter was signed by 38 other state and territory attorneys general.

“PBMs have overtaken the market and now wield outsized power to reap massive profits at the expense of consumers,” said the letter. “The rise of PBMs as middlemen in the prescription drug market has resulted in patients facing fewer choices, lower quality care, and higher prices.”

“PBMs’ use of affiliated pharmacies—pharmacies owned by either the PBM itself or the PBM’s parent company—has exacerbated the problem of manipulated prices and unavailability of certain prescription medications,” the letter said. “Over the past few decades, horizontal consolidation and vertical integration have transformed PBMs from useful administrative service providers into market-dominating behemoths that control the industry.”

A PBM is a third-party administrator of prescription drug programs for health insurers, self-insured employers, and government agencies. PBMs negotiate with drug manufacturers to secure discounts and rebates on medications, manage pharmacy networks, and process prescription drug claims. PBMs also provide services such as medication therapy management and mail-order pharmacy services.

The Federal Trade Commission (FTC) released a report in January that former FTC Chair Lina Kahn said shows that three pharmacy benefit managers (PBMs) — including St. Louis-based Express Scripts, Inc. — have “hiked costs” for a range of prescription medications.

The head of the National Community Pharmacists Association (NCPA) in January sent a letter to the Trump Administration’s newly-created Delivering on Government Efficiency (DOGE) department, asking the department to start its search for waste and fraud with PBMS, reported Patient Daily.

President Donald Trump (R), during a December 2024 press conference, said PBMs are “middlemen” who have contributed to higher drug prices. 

“The horrible middleman that makes more money, frankly, than the drug companies, and they don’t do anything except they’re a middleman,” said Trump. “I don’t know who these middlemen are, but they are rich.” 

The AGs’ letter to congressional leadership said the passage of a law prohibiting PBMs or their parent companies from owning a pharmacy “would foster competition in the marketplace and give consumers more access to pharmaceutical care.”