Yellowhammer Times

Americans are sick of paying the highest prescription drug prices in the world. In Alabama, the strain is real. Families and seniors face out-of-pocket costs among the highest nationwide.

According to federal estimates, over 367,000 Alabama Medicare Part D enrollees are set to save an average of $360 per year on prescriptions in 2025 thanks to new reforms, but more than 61,000 Alabama seniors still spend so much on critical medications that even after a new $2,000 cap, the average savings will be about $1,500—or 56% of their current expenses. For many, these numbers directly affect whether they can access the care they need.

Who’s keeping Big Pharma in check? The answer may surprise you. In the complex world of healthcare, pharmacy benefit managers (PBMs) are the primary force negotiating with pharmaceutical companies to bring down drug costs for health plans, employers, and patients. PBMs use their market leverage to demand discounts, rebates, and better terms from drugmakers. In fact, many health policy experts and even former pharmaceutical executives agree that PBMs are often the only effective counterbalance preventing drug companies from setting prices wherever they want.

Benjamin Rome, an internist and health policy researcher at Harvard Medical School says, “PBMs are the only thing we have to lower brand-name drug prices and prevent the drug industry from charging whatever they want.” Without the negotiating pressure and formulary management that PBMs bring, Big Pharma can charge ever-higher prices for life-saving therapies. In Alabama and across the US, PBMs collectively negotiate price concessions that save payers and patients billions of dollars annually.

That’s why when real accountability is on the table, talk of “PBM reform” dominates the headlines. Big Pharma wants all eyes on PBMs not because they are the source of high prices, but because they’re the last major check on manufacturer pricing power.

Increased transparency and fairness for PBMs, as provided by Alabama’s Community Pharmacy Relief Act (SB252), can help protect independent pharmacies and improve the supply chain. But focusing all legislative firepower on PBMs misses the real point. Only PBMs have the negotiating clout to resist Pharma’s relentless push for ever-higher pricing, and every hour spent debating PBMs is an hour lost from securing real reforms like President Trump’s Most Favored Nation (MFN) pricing rule. It limits how much pharmaceutical companies can charge Americans to amounts paid by patients in other developed countries.

Don’t let Big Pharma off the hook with clever misdirection. Support reforms that empower PBMs to continue standing between Americans and runaway drug prices, and insist on policies like MFN pricing that target the source of the problem. Alabama families, and all Americans, can’t afford anything less.

Chad M. Niblett is a public servant and community relations professional from Mobile.