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Alabama lawmakers are considering competing legislation aimed at reforming the role of Pharmacy Benefit Managers (PBMs), as pressure mounts for federal action to address what many see as a nationwide crisis driving up drug costs and forcing independent pharmacies to close.
Athlete and activist Riley Gaines recently weighed in on the issue, criticizing Alabama’s proposed prescription tax in a post on X. “The Alabama Legislature is pushing a prescription tax that will pad Big Pharma’s pockets while costing consumers and businesses millions,” Gaines wrote. “Instead of letting President Trump and RFK hold Big Pharma accountable, these so-called ‘Republicans’ are doing their bidding.” Her remarks echo growing frustration among business owners and advocates who argue that PBM practices are hurting patients and local economies.
In Alabama, lawmakers are weighing two different approaches. Senate Bill 93, sponsored by Sen. Andrew Jones, would prohibit PBMs from reimbursing pharmacies below actual drug acquisition costs, ban hidden fees, and allow pharmacists to refuse prescriptions that would leave them operating at a loss. Senate Bill 99, introduced by Sen. Larry Stutts, goes further, adding a mandated dispensing fee and requiring reimbursement rates based on national average drug acquisition costs.
The legislation comes as independent pharmacies across the state continue to close. According to the Alabama Pharmacy Association, 36 community pharmacies closed in 2024, and nine more have already shut down this year. Pharmacy owners blame PBM reimbursement practices and administrative burdens that make it impossible to stay afloat.
While state lawmakers try to address the issue, calls are growing for a national solution. President Donald Trump has made PBM reform a priority for his administration, saying during a recent event: “We’re going to knock out the middleman. We’re going to get drug costs down at levels that nobody has ever seen before.” He added, “The horrible middleman that makes more money, frankly, than the drug companies — and they don’t do anything except they’re a middleman — we’re going to end that.”
On Capitol Hill, bipartisan efforts are also taking shape. The Patients Before Monopolies Act, introduced by Senators Elizabeth Warren and Josh Hawley, would ban insurance companies from owning both PBMs and pharmacies, a practice critics say fuels conflicts of interest and anti-competitive behavior.
With pharmacies closing, prices rising, and consumers caught in the middle, momentum is building for comprehensive federal reform. While Alabama lawmakers debate their next move, the solution may ultimately come from Washington, where both political pressure and public demand are making PBM reform a priority.
