Standing inside Pine Plains Pharmacy on Feb. 17, U.S. Rep. Pat Ryan (D-NY-18) called on Congress to address what he described as the “predatory” practices of pharmacy benefit managers (PBMs), urging House Speaker Mike Johnson (R-LA-4) to include oversight measures in the upcoming government funding package. PBMs, which negotiate drug prices and dictate pharmacy reimbursements, face growing criticism for inflating prescription costs and squeezing out independent pharmacies.
Ryan pointed to the accelerating closures of independent pharmacies as proof of the crisis. “At least one community pharmacy per day is closing across the United States because of the greed of just a few companies that have completely taken over our healthcare system,” he said. “It’s morally wrong, and it’s hugely economically detrimental to communities like Pine Plains and so many others.” According to the National Community Pharmacy Association, there has been a net loss of 450 community pharmacies across the country since June 2024.
Joined by local elected officials, pharmacists, and regional healthcare professionals, Ryan argued that PBMs — acting as intermediaries between insurers and pharmacies — wield unchecked influence over drug pricing, to the detriment of consumers and small pharmacies. With the next federal government funding deadline approaching on March 14, Ryan warned that inaction would further jeopardize independent pharmacies and lead to higher prescription drug prices. The spending package presents a renewed opportunity for Congress to pass PBM reforms that were stripped from the December budget.
A July 2024 report from the U.S. House Committee on Oversight and Spending found that the country’s three largest PBMs — CVS Caremark, Cigna Express Scripts, and UnitedHealth Group’s Optum Rx — control 80% of the prescription drug market and generate more than $450 billion in annual revenue. While some industry leaders claim PBM consolidation improves efficiency and lowers drug costs, the congressional report concluded that it has instead driven up prices, reduced pharmacy access, and weakened patient care.
Last year, Ryan co-sponsored two bipartisan legislative efforts to regulate PBMs: the Pharmacists Fight Back Act, which seeks to strengthen independent pharmacies, and the Drug Price Transparency in Medicaid Act, designed to increase PBM accountability. These bills aspire to prevent PBMs from overcharging Medicaid, ensure fair reimbursement rates for pharmacies, and curb PBMs’ ability to steer patients toward corporate-owned pharmacies.
The PBM reform provisions were initially agreed to in bipartisan negotiations but were ultimately removed from the budget by House Speaker Johnson on Dec. 20, 2024. “I’m demanding Speaker Johnson have the courage to stand with the American people and against the Big Pharma companies ripping us all off,” Ryan said.
Nasir Mahmood, owner of Pine Plains Pharmacy, voiced concern over the future of independent pharmacies like his. “We thought that last year [the legislation] would go through, but I think Congress failed us,” he said. ” I hope that this push will bring some fruition and save pharmacies from closure. You know the services we provide.”
“We’ve been taking out lines of credits and money out of our savings to keep our pharmacies going,” said Mark Freitas who owns and operates a community pharmacy in Washingtonville, N.Y. “That’s why you see more than one pharmacy a day closing across the country. It’s gonna be even more than that this year, if this doesn’t get done.”
Pharmacists and advocates say PBM practices disproportionately impact rural and underserved communities, where independent pharmacies are often the only accessible option. Jeanne Valentine-Chase, a Pine Plains resident and longtime customer of Pine Plains Pharmacy, said, “Pine Plains Pharmacy has been my and my family’s pharmacy for over 45 years and is integral to our community, Nasir, Rehan [Mahmood], and their staff provide impeccable care, and it’s vitally important to keep large corporations out of our pockets.”
Local and regional political leaders, including Dutchess County Legislator Chris Drago (D-19), Assistant County Executive Gregg Pulver, and Pine Plains Town Supervisor Brian Walsh, expressed support for Ryan’s efforts. Pulver, a lifelong Pine Plains resident, underscored the urgency of reform. “To think that three companies basically control the pricing of what, in some cases, are life-saving medicines is abhorrent,” he said. “I congratulate the congressman for working bipartisanly to get this done.”
With the March 14 deadline looming, Ryan emphasized the need for public pressure on Congress. “If we don’t pass this, it’s an existential threat to this pharmacy and every community pharmacy in our district. That would be devastating and unacceptable,” he said. “I think we can stop it.”
Having served Pine Plains for decades, Mahmood vowed to continue fighting for the survival of independent pharmacies. When asked whether the continued existence of Pine Plains Pharmacy hinged on the passage of PBM reforms, he did not hesitate. “Definitely,” he said. “Things have been worsening for a long time and this is the last straw, you could say.”