Small Pharmacy Closures Spur Statehouse Battles on PBM Practices

Pharmacy trade groups are pushing for state legislation to regulate pharmacy benefit managers, arguing that PBMs are forcing community pharmacies to close across the US, including regions with few health-care options.

In 2024 state legislative sessions, lawmakers introduced more than 170 bills in 41 states seeking to regulate the entities that manage prescription drug benefits, according to the National Academy for State Health Policy. The top three PBMs—CVS Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s OptumRx—control nearly 80% of the market.

Groups representing small, independent pharmacies and chains unaffiliated with PBMs have focused their advocacy ...