Why PBMs Matter for Rural America and Main Street Pharmacies

Rural communities are the backbone of American agriculture, feeding the country and sustaining countless small businesses, including the heart of Main Street—local pharmacies. Yet right now, misguided legislative and regulatory attacks are threatening to destabilize this vital link in rural healthcare: Pharmacy Benefit Managers (PBMs).

What Are PBMs, and Why Should Rural America Care?

PBMs are critical go-betweens in the prescription drug system, negotiating discounts with drug manufacturers, designing pharmacy benefit plans, and—crucially—helping keep medication affordable and accessible for communities where options can be limited. For rural areas, PBMs are often the reason prescriptions remain filled, delivered, and affordable even when local pharmacies face mounting market pressures.

Affordable Medicines and Pharmacy Survival Go Hand-in-Hand

Your local pharmacy serves as much more than just a place to fill a prescription—it’s often a healthcare lifeline. PBMs help sustain these businesses by negotiating fair reimbursements and enabling mail-order delivery, especially to patients in “pharmacy deserts” common in rural America. In fact, about 30% of veterans, for example, live in rural areas—many depending on mail-order PBM solutions for their medications.

Legislative Overreach: What’s at Stake?

Unfortunately, special interests and some lawmakers are pushing bills (like those in Tennessee and Louisiana) that would severely restrict or break up PBMs, claiming this will help “protect patients.” But let’s be clear—these measures often do the opposite. Restricting PBMs means less negotiating power, higher drug costs, fewer choices, and even pharmacy closures. In Tennessee alone, pending legislation could risk forcing CVS out of the Volunteer state, closing over a hundred of their local pharmacies and leaving rural communities without nearby or mail-order access.

PBMs Are Not the Enemy—They’re Partners in Lowering Costs

According to data, PBMs are projected to save Americans nearly $1 trillion in healthcare costs over the next decade —by keeping drug prices controlled, preventing price gouging, and ensuring fair pharmacy contracting. Their advocacy is directly responsible for keeping out-of-pocket costs for generics as low as $5, and $25 for preferred brands under some programs highlighted by ProtectPharmacies.com.

Who Really Wins When PBMs Are Broken Up?

The primary beneficiaries of breaking PBMs' negotiating power are the large drug manufacturers that would love to set their own prices unchecked. Rural patients would face higher medication costs, and independent pharmacies could be squeezed out of existence completely.

PBMs Help Keep Rural Pharmacies Open—and Rural Economies Strong

Research shows pharmacy benefit companies generate $145 billion in annual savings for society, with a 10:1 return on investment for government and commercial partners. Without PBMs, rural pharmacies would face a 40-50% increase in prescription drug costs, a cost few small-town small businesses or farmers would be able to absorb.

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What Can You Do?

Rural and agricultural communities must demand their lawmakers protect—not politicize—PBMs. If you believe in affordable prescriptions, local pharmacy access, and market competition, take action now:

• Visit https://act.protectpharmacies.com/sign-now/ to send your message to Congress.

• Share this post with your state and local representatives.

• Stand up for Main Street pharmacies and rural healthcare.

  
  

Together, we can keep rural America healthy, competitive, and thriving—by protecting pharmacy benefit managers from misguided attacks.