It’s no secret that Alabama ranks among the worst states in the nation for chronic illness, including diabetes, heart disease, and cancer. These aren’t just statistics—they’re real struggles for working families, seniors, and small-town communities. Given that reality, one would think that access to affordable, life-saving medications would be a top priority for our state. But that access is being restricted by massive corporate middlemen called pharmacy benefit managers (PBMs).
SB 252, now being considered by the Alabama House of Representatives, is a bipartisan effort to rein in PBM abuses and restore fairness to the prescription drug system. The bill has already passed the Senate with no opposition. That rarely happens in Alabama politics, and it speaks to the urgent need for PBM reform.
The opposition to SB 252 is rooted in a fundamental misrepresentation of the facts. One talking point making the rounds suggests employers should ask their HR departments how many prescriptions they covered last year, then multiply that number by $10.64 to find out how much this bill will cost their company. It makes for a clever soundbite and quick indignation—but it’s also incredibly misleading.
SB 252 does not create a new cost for employers or patients. The $10.64 figure being tossed around is a professional dispensing fee that already exists in Alabama’s Medicaid program. It’s not new. It doesn’t go to big drug companies. It’s paid to the pharmacy for the time, labor, and infrastructure required to fill a prescription. And more importantly, the bill clearly states that this fee is to be paid by the PBM or insurer—not by the patient or employer.
If employers want to ask a more legitimate question of their HR departments, they can try this one: How much is your company paying over actual cost for the drugs it covers? Odds are, they won’t get an answer—because most PBMs refuse to disclose claims-level data to the very businesses paying the bill.
That lack of transparency is one of the ways PBMs manipulate drug pricing. That’s not a free-market solution. It’s a closed-door scheme, and employers are footing the bill without ever seeing the receipt.
Meanwhile, patients across Alabama are being steered away from their trusted local pharmacies—many of which are the only healthcare providers in rural communities—and toward PBM-owned mail-order services. Some are denied access to low-cost generics in favor of higher-priced brand-name drugs that generate larger PBM rebates. These are the kinds of business practices that drive up healthcare spending, reduce patient access, and contribute to Alabama’s poor national health rankings.
SB 252 would put a stop to these games by tying pharmacy reimbursement to Alabama Actual Acquisition Cost—a transparent, state-run index of what pharmacies actually pay for medications. It’s fair, it’s measurable, and it prevents the kind of shell games PBMs have been playing for years.
This bill isn’t about politics. It’s about common sense. Employers deserve transparency. Patients deserve access. And pharmacies deserve to be paid fairly for doing their job. That’s why Republicans and Democrats in the Senate supported SB 252 without a single “no” vote.
Alabama has the opportunity to lead the way on PBM reform—and show that we’re not afraid to stand up to billion-dollar corporations when they put profits ahead of people. It’s time to pass SB 252.
Richard Kirby is the Director of Communications for Bessemer-based American Pharmacy Cooperative, Inc., and has been involved with independent pharmacy and PBM reform since 2013.
