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Friday, July 25, 2025 at 5:24 PM

Congress Should Reform PBMs to Protect Patients, & Local Community Pharmacies

Congress Should Reform PBMs to Protect Patients, & Local Community Pharmacies

It isn’t right that insurance companies and the companies they own called “pharmacy benefit managers” (PBMs) are making it harder for patients like me to access the critical medications we need at the local pharmacies that we’ve always gone to. Congress needs to get serious about passing PBM reform that protects patients and our communities from the harm these groups are causing.

From fibromyalgia to insomnia, I’ve struggled with a range of chronic illnesses for the past 20 years. For well over a decade now, I’ve been a loyal client of Sierra Family Pharmacies. It has been difficult to watch as they were forced to close three of their pharmacies in 2017 and 2018, leaving the South Reno location as their last store.  This pharmacy has been serving our region for decades, and is the only compounding pharmacy serving our rural areas in Northern Nevada. 

In fact, I was just there last month filling my prescriptions, frustrated that my insurer and PBM won’t cover those costs. These groups profit by restricting patient access and refusing to cover our needed medications on one hand, while tightening their grip on local, community-based pharmacies on the other.

PBMs should not be able to determine which patients can access which prescription drugs and limit, delay, or deny that access by enforcing harmful, anti-patient policies. They should also not be able to force patients away from their local, community-based pharmacies, like Sierra Family Pharmacies, and toward the larger chain pharmacies that PBMs often own. These practices are quickly putting independent pharmacies out of business. 

Meanwhile, these greedy PBMs are willfully preventing patients from reducing their out-of-pocket expenses at the pharmacy. During their negotiations with drug manufacturers, PBMs take in untold sums in prescription drug rebates. Instead of passing the savings down to patients who struggle with high out-of-pocket expenses, PBMs are keeping most of those savings for themselves to increase their profits.

The Federal Trade Commission is already moving forward with a lawsuit against the three largest PBMs—which together control 80% of the prescriptions filled in the country—for their role in inflating insulin costs for diabetes patients. While this is a good first step, the threat PBMs pose isn’t limited to diabetes patients alone, and there is much more that lawmakers in Washington should be doing to protect patients, local pharmacies, and our entire healthcare system from harmful PBM policies and practices.

Nevada’s congressional delegation should help fight to improve access, lower prescription costs, and protect our neighborhood pharmacies from PBMs that care more about profits than the needs of patients. As Congress works to find and pass a bipartisan solution, lawmakers should also make sure that whatever PBM reform bill they pass ensures greater access to the rebates patients need and more fairness for the local pharmacies that so many of us continue to rely on, despite PBMs’ best efforts to push them out of business.

Alice Heiman lives in Reno and owns Alice Heiman, LLC, a national sales training company. 

 

 


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Comment author: Mike HinzComment text: I knew Sam as a member of our church growing up. He always had a warm smile, a kind word, and a great sense of humor! He will be great missed!Comment publication date: 7/2/25, 11:57 AMComment source: Obituary -- Samuel Bruce WickizerComment author: Mike HinzComment text: Great teacher, great coach, but even a better person!!! Rest in peace Mr. BeachComment publication date: 7/2/25, 11:53 AMComment source: Obituary -- Jack Victor Beach, Jr.Comment author: Mike HinzComment text: I had Mrs Hedges for First Grade at Northside Elementary in 1969. I still, to this day, remember her as a wonderful teacher…one of my favorites!!Comment publication date: 7/2/25, 11:29 AMComment source: Obituary - Nancy Marie Hedges C Comment author: Carl C. HagenComment text: What are MFNs and PBMs ?? ............................ From the editor: This is a very good question and we apologize for not catching that wasn't in there. We reached out to the writer/submitter and got this info back...hope it's helpful. PBM: Pharmacy Benefit Managers are pharmacies that are owned by insurance companies. (CVS is one.) They negotiate with drug makers to get reduced pricing for medications, but they historically have not passed along those savings to patients. https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf MFN: Most Favored Nation pricing is a policy that means a country agrees to offer the same trade concessions (like tariffs or price reductions) to all member nations of the World Trade Organization (WTO). When applied to pharmaceuticals, it could disrupt global access, deter innovation, and obscure the deeper systemic issues in American health care. https://petrieflom.law.harvard.edu/2025/05/22/the-global-risks-of-americas-most-favored-nation-drug-pricing-policy/Comment publication date: 6/23/25, 7:47 AMComment source: L E T T E R TO THE EDITOR
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