Pharmacy benefit managers (PBMs) and their lobbyists have mastered the art of spin. They claim to lower drug prices, increase patient access, and protect consumers, but as they’ve come under scrutiny and investigation, their business practices reveal a different reality. While Congress and state legislatures scrutinize proposed PBM reform laws, these increasingly unpopular middlemen are ramping up their lobbying efforts, flooding lawmakers and the public with misleading narratives.
Still, even with the facts on our side, it’s more critical than ever to be ready to respond.
We’ve assembled a short list of popular PBM lobby talking points along with our responses. To help clarify where you might hear these points, we’ve included context and summaries of longer, researched and source-cited counterarguments (contact us for the complete response to any of the points you see below).
This list is by no means complete or comprehensive - we welcome your feedback and ask you to please send us other opposition talking points you’ve encountered, which we’ll include in our updated “Opposition Talking Points” white paper available in the PUTT Member Library:
Dispensing fees are a “prescription tax” - The word “tax” has become something of a dog whistle - intended to scare vulnerable members of the population (e.g. lower income families, seniors on a limited budget) while also distracting fiscal-minded legislators away from the mounting, documented evidence correlating PBM practices with escalating costs in state and federally-funded healthcare. Several states are considering legislation that would require PBMs to pay pharmacy dispensing fees equivalent to Medicare’s Fee-for-Service dispensing fee.
RESPONSE: A pharmacy dispensing fee is meant to cover the costs associated with filling a prescription, including the labor involved in preparing the medication, storing inventory, packaging supplies, pharmacist consultation, and other operational overhead costs related to dispensing the drug - essentially covering the pharmacy's professional services in fulfilling a prescription. A dispensing fee is necessary since patients cannot bring their own containers for medications, and PBMs and insurers generally do not pay pharmacists for patient counseling and other common healthcare services provided in the pharmacy.
PBMs shouldn’t have to reimburse pharmacies at acquisition cost because those costs are the result of how pharmacies buy drugs. If we reimburse at acquisition costs, that negates the pharmacy’s incentive to shop for the lowest cost option. PBM network pharmacies are a better option for patients because they dispense based on “competitive market rates.” This talking point is often used to refute why PBMs should reimburse pharmacies at their acquisition cost, while conflating reimbursement with what the patient pays at the pharmacy counter.
RESPONSE: This claim misrepresents how pharmacy pricing, PBM contracts, and patient costs actually work. PBMs – not pharmacy acquisition prices – dictate what patients and plan sponsors pay. While pharmacies do buy drugs at different prices depending on volume and timing, PBMs set reimbursement rates, often with little relation to pharmacy acquisition costs. Independent pharmacies utilize multiple resources (secondary wholesalers, buying groups, etc) to shop around to find the lowest cost option for medication.
PBM-controlled networks do not necessarily result in lower costs for patients because PBMs often restrict access to certain pharmacies through preferred networks that do not always offer the lowest price. Research shows that independent and rural pharmacies are often reimbursed below cost, while PBM-owned mail-order and specialty pharmacies receive preferential treatment.
The “Employers Love Us Argument” - This used to be a strong argument, but as PBM practices come under fire, more employers are questioning the value of their PBM and discovering the limitations of the PBM-employer relationship.
RESPONSE: Perhaps the best counter argument can be found in the February 27th testimony of Shawn Gremminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, who listed numerous statistics indicating major employers’ growing concerns with PBM opacity and perverse incentives: 52% of respondents of NAHPC’s annual survey are considering changing their PBM in the next 1-3 years, citing “lack of transparency, concerns about fiduciary responsibility, and embedded conflicts of interest.”
With many large employers and business coalitions exploring alternatives to the “Big 3” PBMs; and others now pushing back against PBMs calling for transparency and reforms or taking legal action against PBMs over unfair pricing practices, you have to ask: If PBMs were truly delivering the best value, why are more employers demanding change?
“Independent Pharmacy is thriving”. This point is often used in combination with state board of pharmacy reports or other misleading lists and can be confusing to the untrained eye.
Response: When it comes to independent pharmacy data, the National Community Pharmacists Association is the authority. Per the NCPA Digest, five years ago, there were some 21,646 independent pharmacies operating in the U.S. As of the 2024 Digest the count is 18,984, a loss of 2662 pharmacies, or approximately 12% fewer independent pharmacies. For arguments implying or directly stating that independent pharmacy is thriving in specific states, NCPA Digest’s Pharmacy Census (see pp. 10-11) quickly dispels the notion that independent pharmacy is “thriving” “booming” or experiencing a comeback in any state. (For quick access to the Digest census pages, contact us here).
The “Free Market” Argument - This is a pernicious argument designed to appeal to conservative legislators who are economic or fiscal hawks. It can be expressed as “(this bill) interferes in the free market” or “Don’t let the government interfere in contracts between private companies” but it belies the reality that where consumers rely on pharmacy benefits for access to medication, there is no free market.
Response: Competitive market forces are distorted by PBM practices.
PBMs often manipulate reimbursement rates and force pharmacies into take-it-or-
leave-it contracts, limiting true market competition. Many independent pharmacies report receiving different, often lower reimbursements than PBM-affiliated pharmacies for the same drugs, making it difficult for them to compete. Because of the nature and structure of the U.S. health insurance industry, there is no free market among providers and no real choice for consumers. The House Oversight Committee report on PBMs showed that due to the market share of the three largest PBMs, pharmacies are often faced with choosing between accepting contract terms or not serving patients.
“Costs will go up”. This argument is classic fearmongering and, so far as we’ve ever been able to tell, has never been accompanied by actual data or explanations of cost drivers.
RESPONSE: When PBMs argue that reform will raise costs, they are really saying they want to keep their opaque pricing schemes intact—not that prices will actually go up under a fairer system. Numerous independent studies and even the WV Insurance Commission bulletin have shown that cutting PBM abuse reduces healthcare spending in the long run by ensuring pricing reflects the true cost of medications—not inflated figures designed to benefit PBMs. PBM reform is about putting patients first, increasing transparency, and eliminating unnecessary middlemen profits—which is exactly why PBMs want to scare consumers into opposing it. The reality is, stopping PBM abuse will lower costs, not raise them.
Conclusion: We Must Be Ready to Bring Our “Receipts”
It’s important we be ready to respond and defend our profession with facts that speak to the urgent need for meaningful reimbursement reform NOW. For years the PBM and insurer lobbies have been able to succeed by planting seeds of doubt with alarming but misrepresented claims of increased costs. And unfortunately, a win for the PBM opposition is as simple as delaying or slowing down progress - which is great for them but a potential death sentence for many pharmacies who are running out of options.
PUTT is here to help you make the case for PBM reform in your state. For information and/or assistance, please contact us.
Yours in advocacy,
Monique Whitney
Executive Director
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