Washington, D.C. – Following news that a bipartisan group of 39 state and territory attorneys general sent a letter to congressional leaders urging them to pass legislation prohibiting pharmacy benefit managers (PBMs) from owning or operating pharmacies, the American Economic Liberties Project released the following statement.

“Congress must pass the Patients Before Monopolies Act to structurally separate PBMs and pharmacies given the conflicts of interest inherent to their common ownership,” said Benjamin Jolley, PharmD, Senior Fellow for Healthcare at the American Economic Liberties Project. “It should be illegal for CVS Health’s PBM, Caremark, to be in charge of paying pharmacies while its sister subsidiary, CVS Pharmacy, is the biggest pharmacy chain in the country. The temptation is too strong for CVS and other Big Medicine healthcare conglomerates to steer patients and revenue to their affiliates, squeezing independent pharmacies out of business and stranding vulnerable patients in pharmacy deserts. We’re thrilled to see so many Republican and Democrat state AGs join the fight to break up Big Medicine and urge Congress to do the same.”

PBMs are middlemen who negotiate prescription drug benefits on behalf of health plans with drug manufacturers and pharmacies. The “Big Three” PBMs – CVS Caremark, Cigna Group’s Express Scripts, and UnitedHealth Group’s OptumRx – control nearly 80% of U.S. prescription drug claims. They leverage this market power to demand untenably low reimbursement rates from independent pharmacies in exchange for inclusion in their networks. Many pharmacies accept these rates for fear of losing access to a large share of their customer base. But these rates are accelerating the pharmacy closure epidemic. Economic Liberties research shows that at least 3,179 – or more than 5% of – U.S. pharmacies closed between January 2024 and February 2025.

The bipartisan Patients Before Monopolies Act (S.5503, H.R. 10362) – introduced by Sens. Elizabeth Warren (D-MA) and Josh Hawley (R-MO) and Reps. Jake Auchincloss (D-MA-04) and Diana Harshbarger (R-TN-01) late last session – would force insurers and PBMs to divest their pharmacy businesses within three years. Earlier this month, Arkansas became the first state to pass its own structural separation bill, HB 1150, which is awaiting Governor Sarah Huckabee Sanders’ signature.

Learn more about the Break Up Big Medicine initiative here.

Learn more about Economic Liberties here.

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The American Economic Liberties Project works to ensure America’s system of commerce is structured to advance, rather than undermine, economic liberty, fair commerce, and a secure, inclusive democracy. Economic Liberties believes true economic liberty means entrepreneurs and businesses large and small succeed on the merits of their ideas and hard work; commerce empowers consumers, workers, farmers, and engineers instead of subjecting them to discrimination and abuse from financiers and monopolists; foreign trade arrangements support domestic security and democracy; and wealth is broadly distributed to support equitable political power.