Issues
Today, the three largest PBMs operating in Rhode Island stand accused by the Rhode Island Attorney General of unfairly and deceptively increasing the costs of prescription drugs, limiting care choices for Rhode Islanders, and harming local, independent pharmacies. These PBMs are also facing lawsuits elsewhere in the country and federal court rulings detailing hundreds of millions of dollars in overbilling.
Rhode Island's independent pharmacy owners have joined forces to support the Attorney General's lawsuit and push for PBM reform. This website provides valuable information explaining why PBM reform is so important.
Holding PBMs Accountable: A closer look at how PBMs hurt patients and independent pharmacies.
Pharmacy Benefit Managers (PBMs) were established decades ago to help employers and health plans manage prescription drug benefits, process claims, and negotiate discounts with pharmacies and drug manufacturers with the aim of reducing overall prescription drug spending.
Today, the three largest PBMs operating in Rhode Island stand accused by the Rhode Island Attorney General of unfairly and deceptively increasing the costs of prescription drugs, limiting care choices for Rhode Islanders, and harming local, independent pharmacies. These PBMs are also facing lawsuits elsewhere in the country and federal court rulings detailing hundreds of millions of dollars in overbilling.
The 84-page lawsuit filed against CVS Caremark, Express Scripts and OptumRx by Rhode Island Attorney General Peter Neronha details violations of the law, predatory practices against independent pharmacies and anti-consumer behavior that puts PBM profits ahead of Rhode Island patients. Among the many examples cited in the AG’s lawsuit is the use of their dominant market power to force independent pharmacies like ours to accept reimbursement at or below our acquisition costs while steering more profitable prescriptions to their own pharmacies. This has forced many independent pharmacies in Rhode Island to close over the years.
With each pharmacy closing, Rhode Islanders lose a trusted healthcare provider and the personalized service only an independent pharmacist can offer, including medication management, home deliveries, and even after-hours support during an emergency.
Together, we’re supporting the Attorney General’s lawsuit while asking hard questions of others who seek leadership roles and know the system best. That includes Helena Foulkes, a former CVS Health executive running for governor. She should make clear where she stands on PBM reform. Will she support the AG’s lawsuit? Will she call on the General Assembly to adopt the PBM reforms Congress just passed? Will she urge the General Assembly to codify the protections for independent pharmacies included in the Federal Trade Commission’s recent settlement agreement with Express Scripts, who was sued, along with CVS Caremark and Optum Rx for inflated insulin prices?
See the following links to press releases, reports, lawsuits and legal rulings about PBMs and PBM reform.
Employers, do you know what restrictions your Pharmacy Benefit Manager is forcing on your employees?
Employers understand that one of the most important employee benefits is health insurance that includes prescription drug coverage. Employers also understand how costly these benefits have become, a reality that has employers looking at every opportunity to save while still delivering a valuable benefit to employees. Rising health insurance costs affect employees too, whether through increased cost sharing with employers or rising co-pays and co-insurance expenses.
In this environment, some health insurance providers and their Pharmacy Benefit Managers will offer cost saving approaches to employers without explaining how cost saving moves can adversely impact employees.
Employers should learn more before agreeing to cost saving measures that PBMs and health insurance providers offer without explaining how employees will be adversely impacted.
One of the ways PBMs and health insurers will try to save costs is by restricting formularies, the list of available drugs in a health benefit plan. This may present serious challenges to employees, especially those with chronic health conditions.
The May 2025 lawsuit filed by Rhode Island’s Attorney General, Peter Neronha, against CVS Caremark, Express Scripts and Optum Rx details examples of these PBMs hiding information from employers about the financial benefits PBMs derive from making formulary changes.
The National Alliance of Healthcare Purchasing Coalitions supports policies that would require PBMs to make pricing data available to payers and compel drug companies to report and justify price increases for some medications. The U.S. Department of Labor is also pushing for PBM transparency, proposing a landmark regulation in January 2026 that would bring overdue transparency to the fees and compensation pharmacy benefit managers receive.
Employers interested in learning how Rhode Island’s independent pharmacies can deliver cost-saving value to employers while still providing employees the medicines they need are encouraged to contact us at info@savemylocalpharmacy.org.