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Alabama’s push for Pharmacy Benefit Manager reform has been framed as a win for independent pharmacies, but a closer look at Senate Bills 93 and 99 suggests that the biggest beneficiaries may be large retail chains and big-box stores. While the legislation aims to level the playing field for pharmacies, the $10.64 dispensing fee is not exclusive to independent drugstores—major retailers like CVS, Walgreens, Walmart, and Publix stand to collect substantial additional revenue.
During a recent public hearing, Pat McWhorter, a contract lobbyist representing Walmart, Publix, and the Alabama Grocers Association, acknowledged the real battle over prescription drug pricing is at the federal level, not in Montgomery.
“The root of the problem … is not here. The root of the problem is in Washington,” McWhorter told legislators. He pointed to the influence of the National Pharmaceutical Research and Manufacturers Association, which he claims spent “somewhere close to $150 million lobbying Congress” to maintain the current system.
McWhorter represents two of Alabama’s largest retail chains: Publix, which operates 90 stores in the state, and Walmart, with 145 to 150 locations, most of which include in-store pharmacies. While independent pharmacies have long advocated for PBM reform, the sheer footprint of these corporate giants suggests they will capture a significant share of the financial benefits.
A Level Playing Field—or a Corporate Windfall?
McWhorter argues that Walmart and Publix do not own PBMs, unlike some of their competitors, which use their PBM structures to negotiate drug prices and insurance reimbursements in ways that favor their own pharmacies. “My members do not own a PBM. They compete with drugstores that do own PBMs. That’s not a level playing field for us,” he said.
Supporters of PBM reform say the legislation is necessary to prevent pharmacy closures, particularly in rural areas. However, the financial dynamics at play raise questions about whether independent pharmacies will see meaningful relief—or if the bulk of the benefits will flow to large retailers with extensive pharmacy operations.
A Health Care Crisis Beyond PBMs
McWhorter’s testimony also underscored the broader health care crisis in Alabama, where rural hospitals and emergency rooms continue to shut down. “We closed another ER in a rural county this week,” he noted. “We’ve got pharmacies closing everywhere.”
But while Alabama legislators debate the merits of PBM reform, McWhorter’s experience abroad highlights a different issue—drug pricing itself. He shared a personal anecdote about purchasing a diabetes medication in Istanbul for $20 a month, compared to the $1,000 price tag in the United States. That staggering disparity, he suggested, is driven by pharmaceutical industry lobbying in Washington, which keeps U.S. drug prices among the highest in the world.
As Alabama moves forward with PBM reform, the question remains: Will these bills truly support struggling independent pharmacies, or will corporate chains reap the biggest rewards? While the legislation aims to address local disparities, the deeper issues of drug pricing and pharmaceutical industry influence remain entrenched at the national level.
