I am particularly encouraged by the Newsmax Article that came out today that summarizes a growing bipartisan movement—at both the state and federal levels—to regulate pharmacy benefit managers (PBMs), which have long been one of the biggest financial pressures on independent pharmacies.
The key takeaways are:
- States are requiring greater PBM transparency.
- Many states are establishing minimum pharmacy reimbursement or dispensing fees.
- Some states are banning or limiting “spread pricing.”
- A few states are challenging the practice of PBMs owning competing pharmacies while also controlling reimbursement.
For an independent pharmacy owner, here is what matters most.
1. The political environment has shifted
For years, PBM reform was discussed but little changed. Today, there is unusual bipartisan agreement that PBMs deserve greater oversight.
Whether legislators are conservative or liberal, many now believe PBMs have become too powerful and insufficiently transparent. That doesn’t guarantee sweeping reform, but it makes meaningful changes much more likely than they were even a few years ago.
2. Reimbursement pressure may finally ease
If states require:
- minimum dispensing fees,
- more transparent reimbursement formulas,
- or prohibit below-cost reimbursements,
many independent pharmacies could see improved margins on prescriptions.
That won’t suddenly make every pharmacy highly profitable, but it could reduce one of the industry’s biggest challenges.
3. Vertical integration is under attack
The largest PBMs are affiliated with:
- CVS
- Express Scripts
- OptumRx
Critics argue these companies can influence reimbursement while simultaneously competing against independent pharmacies.
Several states are directly challenging that business model. Tennessee, for example, has enacted legislation that would prohibit PBMs from owning retail pharmacies beginning in 2028, although it is currently being challenged in court.
If similar laws spread, independent pharmacies could compete on a more level playing field.
4. This could improve pharmacy valuations
As a business broker specializing in pharmacy transactions, this is one of the most interesting implications.
When buyers evaluate pharmacies, one of their biggest concerns is:
“Will reimbursement continue to deteriorate?”
If reimbursement stabilizes—or even modestly improves—buyers generally become more willing to acquire pharmacies because future cash flow appears more predictable.
Higher confidence often translates into:
- more buyers,
- stronger purchase multiples,
- easier financing,
- and higher sale prices.
It won’t happen overnight, but improving regulatory conditions tend to support business values.
5. Don’t expect immediate financial improvement
Most reforms:
- take months or years to implement,
- will likely face lawsuits,
- require insurers and PBMs to adjust contracts,
- and may vary significantly from state to state.
A pharmacy owner should avoid assuming next month’s reimbursements will suddenly improve.
6. Pharmacy owners should still focus on fundamentals
Even if PBM reforms succeed, buyers continue to place the greatest value on pharmacies with:
- strong net income,
- growing prescription volume,
- diversified revenue streams,
- adherence programs,
- immunizations,
- long-term care or specialty services,
- and limited dependence on a single payer.
Regulatory improvements can enhance value, but they won’t replace solid business performance.
Bottom line
If I owned an independent pharmacy, I would view this story as another sign that the industry may be reaching an inflection point.
For years, the dominant trend was worsening reimbursement and increasing PBM leverage. Now, both states and the federal government are pursuing reforms that could improve transparency, reduce some PBM practices, and strengthen the position of independent pharmacies. Recent federal legislation also increases PBM transparency and changes aspects of Medicare Part D compensation beginning in 2028.
For pharmacy owners who may be considering selling in the next 2–5 years, these developments could improve buyer sentiment and potentially support stronger valuations if the reforms are implemented effectively.
I can also explain how these PBM reforms could affect the market value of an independent pharmacy in 2026–2028, including what sophisticated buyers and private equity firms are likely to pay attention to during acquisitions.