Pharmacists have always been on the front lines of patient care, serving as one of the most accessible and trusted healthcare professionals. But in today’s rapidly changing pharmacy landscape, their role extends far beyond dispensing medication. They’ve become advocates who champion for fair reimbursement, patient access, and a sustainable future for independent community pharmacies.
That was the central message of my recent presentation, “The Pharmacist as an Advocate,” hosted by the Ohio Pharmacists Association (OPA). Speaking to OPA members, I shared insights from my experience representing pharmacies and healthcare organizations across the country. My goal was simple: to encourage pharmacists to recognize their power as both healthcare providers and business owners, and to use that influence to push back against unfair PBM practices, protect their patients, and preserve their profession.
Background and PBM Overview
Over the past decade, we’ve seen an unprecedented consolidation within the pharmacy benefit manager (PBM) industry. A handful of PBMs now control nearly 85% of all prescription claims in the United States. This concentration of power has allowed them to dictate reimbursement rates, audit standards, and network participation while at the same time competing directly with independent and chain pharmacy with their wholly owned retail, mail order and specialty pharmacies.
PBMs were originally thought to manage prescription benefits for health plans, but the system has evolved into one that is often opaque, inconsistent, and inequitable. Independent pharmacies now find themselves navigating unilateral contract changes, reduced reimbursements, and unpredictable audits that can upend operations and threaten patient care.
In my presentation, I emphasized that proactive advocacy and legal awareness are essential. Pharmacists must understand their contracts and their rights under state and federal law. For instance, under the “Any Willing Provider” provision in Medicare Part D, plan sponsors and PBMs must allow qualified pharmacies to participate under reasonable and relevant contract terms and conditions. Knowing when and how to challenge unfair or inconsistent practices can make a significant difference in protecting your business.
But advocacy doesn’t end with compliance. I urged OPA members or any pharmacist to become active participants in legislative and regulatory advocacy. Lawmakers and regulators need to hear from community pharmacy professionals to explain and provide real world examples of unregulated PBM conduct. Importantly, it doesn’t always take hundreds of voices to make an impact, just a few pharmacists sharing their stories can influence policy decisions at the state or federal level.
Because of those pharmacy professionals who have already spoke up states like Ohio have taken meaningful steps toward PBM oversight, implementing licensing requirements and increasing transparency around reimbursement and audits. Other states, including New York, have established dedicated PBM regulatory bureaus giving pharmacies a direct channel to file complaints and hold PBMs accountable.
Proactive Strategies for Pharmacists
I encourage pharmacists to take advantage of these mechanisms. Every voice matters. Filing with your state department of insurance or health agency helps build a record regulators can’t ignore. Consistent reporting not only raises awareness, it creates the data regulators need to act.
At the federal level, the Federal Trade Commission (FTC) has launched investigations into PBM operations, focusing on transparency, conflicts of interest, and market control. While progress has been gradual, these efforts have already elevated the national conversation around PBM reform and the need for greater accountability.
Still, real change will only happen if pharmacists remain engaged. Advocacy isn’t something that happens once a year during legislative visits, it’s an ongoing process. Every audit appeal, every contract review, every policy conversation adds momentum. As I told OPA members, your advocacy matters. Every letter, every call, and every story strengthens the case for fair treatment.
Independent pharmacies are the backbone of community healthcare, but they can’t continue to carry that weight without systemic change. Advocacy, education, and collaboration are the keys to leveling the playing field. While the legal landscape can be complex, pharmacists don’t have to navigate it alone.
How Frier Levitt Can Help
At Frier Levitt, our team has spent more than two decades helping independent pharmacies and healthcare providers navigate PBM audits, DIR fee disputes, network terminations, and reimbursement challenges. With more than 50 attorneys, many of whom are also licensed healthcare professionals, we bring a deep understanding of both the legal and clinical sides of the industry.
We’ve helped pharmacies recover millions in withheld reimbursements, defend against aggressive audits, and challenge PBM practices that overstep legal boundaries. Beyond direct representation, we also collaborate with pharmacy associations and advocacy groups nationwide to help draft and support legislation that protects independent providers and promotes transparency.
For pharmacists who feel the pressure of PBM practices or uncertainty about their compliance obligations, taking a proactive legal approach is one of the best forms of advocacy. Strengthening documentation, understanding your contracts, and knowing when to push back can help prevent costly disputes and protect both your business and your patients.
As I shared during this presentation, pharmacists are more than dispensers, they’re problem-solvers, advocates, and community leaders.
If your pharmacy is navigating PBM challenges, compliance concerns, or reimbursement disputes, Frier Levitt can help.
