PUTT BLOG | We're Calling for Aggressive PBM Reform NOW

PUTTbulletin July 2025

The politics of pharmacy and PBM reform have reached an inflection point. The era of incrementalism, such as it existed, is over. We’ve demonstrated that we’re hardworking team players, capable of being gracious and accepting when our part of PBM reform policy ends up on the cutting room floor because, well, “politics”. We’ve seen the movie making its second, third or fifth run through the halls of Congress this year and we know how it ends.

So to you, to our fellow advocates and pharmacy organizations, we are saying:

The time is NOW. There will never be a better opportunity to swing out big for aggressive, meaningful PBM reform. 

If we’re serious about reforming how PBMs engage with pharmacies we must ask for everything we need, and we must continue to ask and advocate for it until we get it, NO COMPROMISES.

As I write this letter, I see several areas of “no compromise” including:

• Full drug acquisition cost reimbursement, plus dispensing fee, plus a reasonable margin in all plans - regardless of private or publicly funded

• No PBM-owned pharmacies and no apologies for demanding this. PBMs should either be benefits managers or pharmacy owners but not both

• Patient choice of pharmacy at all times: no mandatory mail order, no steering to “preferred” pharmacies, no exclusions, no narrow networks

• Criminal penalties for PBM violations of the law

This is why the Pharmacists Fight Back Act and the Patients Before Monopolies Act matter and why we must accept nothing less than what they provide. These bills are the model for what we must ask for moving forward.

To be clear, we are not disparaging Representative Carter’s 2025 “stand alone PBM bill” or other PBM reform bills that protect the interests of other members of the pharmaceutical supply chain. 

Also to be clear, we understand there are dynamics, such as Congressional Budget Office scoring for costs and savings. But it is incumbent upon us to demonstrate how costs are an investment in the long-term savings the federal and state governments will realize if they protect pharmacies and actually stop the well-documented profiteering practices of the largest PBMs and their MCO parents.

This is no time to take an “oh gosh, we don’t want to create ‘pharmacy fatigue’” stance or whatever other seemingly rational, careful excuses we might tell ourselves. That ship has sailed anyway - if the “I’m so tired of hearing about PBM reform” comment made by a Senate Health staffer from the stage at ThoughtSpot 2025 is any indication. 

With the Trump Administration unabashedly unafraid of taking big, bold risks, we MUST ask - clearly, directly, specifically, FULLY - for what we need to ensure every American has access to care. That or we might as well pack up our pharmacies now, because slowly but surely that future is coming for us whether we swing out big or not.

Let’s not be the living example of insanity. Let’s channel the spirit of our NARD forebears and once again be tough, proud, unembarrassed and unafraid to ask for ALL that we need, and keep asking until we get it. No compromises this time. 

Yours in advocacy,

Monique Whitney, Executive Director