By Brian Hose

Independent pharmacies across Maryland are singularly focused on one urgent priority: pharmacy benefit manager (PBM) reform. As Congress considers the future of healthcare policy, the opportunity to take meaningful action on PBMs is here—and it must not be missed. For too long, these corporate middlemen have driven up drug costs, squeezed local pharmacies to the point where many have gone out of business, and limited patient access to affordable medications. As an independent pharmacy owner in Maryland and the CEO of EPIC Rx, I have seen first-hand the detrimental effect on our communities.

Maryland’s congressional delegation, and every member of Congress, has a critical chance to act now, building on the body’s prior success in lowering prescription drug costs. We need PBM reform, and we need it now.

PBMs wield enormous power in our healthcare system. Originally intended to manage drug plans and negotiate discounts on behalf of patients, these entities have evolved into profit-driven intermediaries forcing higher costs on patients. Today, three PBMs control nearly 80% of the market, giving them significant leverage over drug pricing, pharmacy reimbursements, and patient access to medications. This consolidation allows PBMs to determine which drugs are covered, how much patients pay out of pocket, and even which pharmacies survive.

Independent pharmacies, in Maryland and across the country, have felt the brunt of PBM practices. These small businesses—many of them family-owned and deeply rooted in their communities—are struggling to stay afloat due to below-cost reimbursements and retroactive fees imposed by PBMs. Every time a local pharmacy closes, patients lose a vital point of care, especially in rural and underserved areas where these pharmacies often serve as the primary healthcare providers.

Our communities have already seen the negative impact of unchecked PBMs, with increasing closures of community pharmacies and patients forced to travel farther to get their medications. In some cases, PBM-owned mail-order services are the only option, leaving patients with fewer choices and less personalized care. This trend is unsustainable—and it’s harming the people who can least afford it.

The push for PBM reform is not just about supporting small, independent pharmacies like mine and the communities we service—it’s about putting patients first. Reform will inject transparency into a system that has operated in the shadows for too long. It will ensure that the savings negotiated between PBMs and drug manufacturers are passed along to patients rather than being pocketed by intermediaries. PBM reform will protect small pharmacies from predatory practices, giving them a fair chance to serve their communities and compete on a level playing field.

We have worked diligently with the Maryland General Assembly to help pass some small relief, but we can’t compete with companies listed near the top of the Fortune 25 biggest companies. Every time we close one loophole, they just find another way to gouge patients and their pharmacists.

Now, Maryland’s congressional delegation can and must play a leading role in this effort. Congress has already laid the groundwork with historic efforts to lower prescription drug prices, such as the Inflation Reduction Act’s Medicare reforms. But PBM reform is the crucial next step in this journey. Without it, patients will continue to pay more for medications, and local pharmacies will continue to close their doors.

The opportunity to pass PBM reform is here, and the time to act is now. Maryland’s members of Congress have a chance to build on the progress already made by embracing this reform, ensuring that the savings and benefits of drug price reductions reach patients—not just corporate middlemen. Delay is not an option.

Independent pharmacies are ready to do their part, but they need the support of Congress to succeed. Maryland’s lawmakers have a responsibility to act decisively—reform PBMs, reduce the cost of prescriptions, and preserve access to care for patients everywhere. They have their chance over the next couple of days to start helping independent pharmacies by voting “yes” on the spending package before them. Let’s put patients first, protect our local pharmacies, and make sure that the healthcare system works for everyone. The time for PBM reform is now.

Brian Hose is an independent pharmacy owner in Sharpsburg, Maryland and the CEO of EPIC Rx, a national leader of pharmacy services support for independent pharmacies.