PUTT Blog | 2026 PUTT Virtual Summit Recap: Passing Laws Isn't Enough

This year's Summit tackled the question every independent pharmacy owner and medical professional is asking: Why aren't PBMs following the laws we fought so hard to pass? The answer, from every speaker, was that enforcement takes funding, evidence, and people who keep showing up.

Keynote: Mark Boesen, PharmD JD (Boesen & Snow Law)

Pharmacist-attorney Mark Boesen called 2026 the most hopeful moment for independent pharmacy in 30 years. His reasons were new allies from Mark Cuban to the FTC, and lawmakers who are done with PBM excuses. He also named the problem plainly. PBMs ignore laws because they're big enough to dare pharmacies to sue. Some label audits "fraud investigations" to sidestep fair-audit laws. In Arizona, after transaction fees were banned, CVS Caremark began charging a 30-cent "regulatory compliance fee," and contesting any of it in arbitration can cost a pharmacy hundreds of thousands of dollars. 

His advice:

• Stop letting fear sign bad contracts. He cited a pharmacy losing $500K a year on one PBM contract that could have turned a profit on cash-priced generics.

• Find your niche. He described one Arizona pharmacy that grew from a clinic storefront into a billion-dollar specialty business by filling gaps the chains wouldn't. Veterinary compounding, telehealth kiosks and clinical services are open doors today.

• Show up for lawmakers. A $500 fundraiser and an hour in a conference room turned a first-time candidate into Arizona's Senate Health & Human Services chair, and a leading PBM reform voice. Call your legislators; they want to hear from you..

Turning audits into evidence: Pharmacy Marketplace

Kris Rhea shared first-year results from a workflow that helps pharmacies file state-law MAC appeals. Pharmacy Marketplace has filed more than 60,000 successful appeals, returning over $800,000 to 258 pharmacies in about 20 states, an average of $16 per claim. Every appeal also creates a documented record regulators can use to hold PBMs accountable. 

Enforcement Game Changers Panel: The Road to Accountability - Enforcement, Divestiture and Outlawing PBM Games 

PUTT’s Lauren Young moderated a panel of game changers passionate about getting the enforcement work done: John Vinson, CEO of the Arkansas Pharmacists Association (APA); Stacy Cooper, APA president and local pharmacy owner; Greg Reybold, VP of Healthcare Policy and General Counsel at APCI; and Jackie Martella, a Pennsylvania pharmacy owner.

• Arkansas: What enforcement looks like when it's funded. Arkansas raised PBM licensing fees to fund real enforcement. The past 12 months have resulted in more PBM enforcement there than the previous 10 years combined, and the state’s new prompt-pay law is already producing interest checks for pharmacies. John also reported a recent appellate court  win upholding Arkansas's cost-to-dispense rule, expected to take effect January 1, 2027

• Federal Teeth: The Pharmacists Fight Back Act. Greg noted that some states with the strongest-looking PBM laws are among the least enforced. The Pharmacist Fight Back Act aims to fix that federally. The updated FEHB bill (H.R. 6610) advanced in July with fines of up to $10 million per violation, escalating penalties and possible removal from the program. As Greg put it, a small fine on a large-scale violation is still a good day at the office for a PBM..

• A law on the books isn’t a remedy. Pennsylvania pharmacy owner Jackie Martella’s pharmacy was terminated from Express Scripts' network in May 2025. After she told her story in person to lawmakers from both parties, Pennsylvania added language to its fiscal code, signed by Gov. Josh Shapiro in July. It says a pharmacy in good standing with the Board of Pharmacy and DEA can't be kept out of Medicaid networks after 12 months. Guidance was issued in August, and she's still waiting to be reinstated. Her lesson: legislators write laws, but agencies enforce them. You need relationships with both. 

The panel's top ask: file complaints, even small ones. Some state regulators haven't received a pharmacy complaint in months.

Senator Elizabeth Warren and the Break Up Big Medicine Panel

Senator Warren urged pharmacists to back the bipartisan Patients Before Monopolies Act and Break Up Big Medicine Act, which she introduced with Senator Josh Hawley. Nearly 4,000 independent pharmacies have closed since 2019, and the Senator vowed she would keep fighting but needs our help. 

Her message segwayed perfectly into the final panel titled The Independent Pharmacist Advocacy Playbook: Practitioners Against Big Medicine. 

Dr. Amy Adair (Alliance of Independent Dentists), Dr. Eric Fethke (Doctors for America),  and PUTT’s own Monique Whitney were joined by American Economic Liberties Project Senior Fellow for Healthcare Emma Freer to show how the PBM playbook is now hitting every corner of healthcare, and how pharmacy advocacy has become the model for fighting back. Their overall message: Enforcement is a Team Sport.

• Use the systems that exist. Dr. Adair tells fellow dentists to file complaints with the insurance commissioner. She did, and her problems dropped.

• Organize patients. Jackie Martella's town hall drew more than 350 people and helped pave the way for Pennsylvania's new law.

• Use the courts. When an Oregon hospital tried to replace its local ER doctors with a private equity–backed firm, the doctors sued under the state's new corporate-practice law. The hospital backed down before a judge ruled. That law inspired the new federal Stop Corporate Takeovers of Physicians Act.

• Push legacy organizations. National medical and dental groups often stay neutral. Dr. Adair and Dr. Fethke’s response: how many patients are hurt if we don't take a stand?

What's Next

Winning PBM reform laws is only half the fight. Earlier this year, audits in some of the states with the strongest laws showed PBMs routinely ignoring them. That’s why PUTT’s focus over this next year will be enforcement, driven by the question “What will it take to make PBMs follow the law?” That work will be the driving force behind next year’s In-Person Summit. Stay Tuned - you won’t want to miss this! Location and details are coming soon.