PUTT Blog | The Chamber of Commerce Is Missing in Action on PBM Reform - And It's No Accident

Independent pharmacies are small businesses. That shouldn’t be a controversial statement. We employ local residents, serve vulnerable communities, and operate on razor-thin margins while navigating an increasingly monopolized healthcare system. So why is it that when we fight for fairness in drug pricing and reimbursement, the very institutions that claim to champion small businesses — state and national Chambers of Commerce — are nowhere to be found?

Worse yet, many Chambers are actively opposing PBM reform. This isn’t just a disconnect. It’s a deliberate shift — one that reflects how far the modern Chamber has moved away from its Main Street roots. And when it comes to pharmacy benefit manager (PBM) reform, that shift has real consequences.

The Chamber of Commerce’s Original Mission: Small Business, Local Economy

Chambers of Commerce were founded to support local economic development, amplify small business voices, and help communities thrive. At the local level, many still do exactly that. But over the past few decades — at the State level and especially at the national level — their priorities have changed. What once was a coalition of mom-and-pop shopkeepers has become a lobbying powerhouse for multinational corporations. Today, the U.S. Chamber of Commerce and many state chapters are deeply aligned with the interests of big insurers, big pharma, and — by extension — PBMs.

You don’t need to look far to see why. Corporate funding drives policy. Board seats are filled by executives from companies like CVS Health, Cigna, and UnitedHealth Group. And when reform threatens those entities, the Chamber doesn’t hesitate to step in and defend them — even if it means throwing small businesses under the bus.

How did PBMs capture the Chamber agenda?

The pharmacy benefit manager model was sold to policymakers as a way to reduce drug costs and streamline benefits. What emerged instead was a complex web of vertical integration, opaque pricing, and anti-competitive practices that squeezed out independent providers and padded profits for middlemen. As PBMs became central players in the healthcare industry — controlling nearly 80% of all prescription drug claims through three corporations — they also became major stakeholders in the Chamber’s political apparatus. That influence didn’t just buy a seat at the table. It rewrote the agenda.

So when PBM reform bills crop up — bipartisan efforts to introduce pricing transparency, ban spread pricing, or ensure fair pharmacy reimbursements — Chamber opposition often follows.

The arguments? You’ve heard them before:

“This will increase costs.”

“We need to preserve flexibility in benefits.”

“Government shouldn’t interfere in private negotiations.”

But behind the talking points is a simple truth: the Chamber is protecting PBMs because PBMs are protecting the Chamber’s biggest funders.

There is now a double standard in Small Business rhetoric from the Chamber. This is where it gets personal. Independent pharmacies don’t have billion-dollar lobbying arms or pay for D.C. ad blitzes. We’re small business owners serving real patients in real communities — and yet when we show up with data, receipts, and firsthand accounts of being reimbursed below our cost to dispense, the Chamber doesn’t show up with us.

And while the Chamber may claim to be neutral, that is definitively not the case. In state after state, Chamber affiliates have opposed PBM regulation — even when the reforms are designed specifically to protect small businesses from predatory reimbursement practices.

You don’t get to claim the “support local” banner if your policy playbook is written by Fortune 50 companies.

There is a better path forward.

Not every Chamber chapter is complicit. Some local and regional chambers understand what’s happening and are advocating for their members. But the national voice — and too many state-level chapters — have made it clear: when forced to choose between their stated mission and their largest donors, they’re siding with the money.

That can change. And it should. Chambers of Commerce still have the reach, the influence, and the credibility to support real reform. But they need to recognize that supporting small businesses means more than cutting red tape or lowering tax rates. It means protecting them from monopolistic practices that make true market competition impossible.

A Message for Our Chambers of Commerce:

Look at your membership. Do you represent community pharmacies? Are you listening to them? Look at your policy positions. Do they reflect what’s best for local economies — or what’s best for shareholders? Look at your silence. Who benefits when you say nothing?

And if you’re a policymaker: remember that “pro-business” should not mean “pro-monopoly.”

Real reform means asking tough questions, challenging entrenched interests, and backing the small businesses that actually deliver care — not the intermediaries that profit off restricting it.

Independent pharmacies don’t need lip service. We need a level playing field. If the Chamber isn’t willing to fight for that, then maybe it’s time small businesses redirect their support to those who are willing to show up for them.

Brandi Chane, PUTT Executive Board Member