Bryan Kiefer, co-owner and pharmacist at Jones Drug Store, said on March 6 that independent pharmacies are being aggressively pushed out of business by the monopolistic practices of pharmacy benefit managers (PBMs). Kiefer argued that insurer-owned middlemen use vertical integration and market power to squeeze independent pharmacies, distort reimbursement, and raise costs for patients.
Kiefer said the consolidation in the health care system is hurting pharmacies, providers, and ultimately reducing access for patients through higher costs. He pointed to large insurance companies such as UnitedHealth Group, Aetna, and Cigna and their PBMs or self-owned pharmacy operations as key players in this trend. "It’s massive insurance companies such as UnitedHealth Group, Aetna and Cigna and their PBMs or self-owned pharmacy operations that are hurting independent pharmacies and buying up clinics... In recent years, they have even gone so far as to create shell companies overseas, group purchasing organizations, that help their PBMs skirt U.S. regulations and retain profits that are meant to help drive the price down for patients," Kiefer said according to a guest opinion published in the Southeast Missourian.
The Federal Trade Commission (FTC) said in its July 2024 interim PBM report that the six largest PBMs now manage nearly 95% of all prescriptions filled in the United States. The agency said increasing concentration and vertical integration have allowed PBMs to profit while squeezing independent pharmacies and patients, directly reinforcing Kiefer’s argument that the problem is not abstract inefficiency but the market power of insurer-linked middlemen according to the FTC.
In its January 2025 second interim report, the FTC found that the "Big 3" PBMs generated more than $7.3 billion in revenue above estimated acquisition cost on specialty generic drugs from 2017 through 2022. The report said those firms marked up many lifesaving medicines by hundreds or even thousands of percent, offering a concrete example of how PBM-linked pricing practices can drive up costs across the healthcare system according to the FTC.
PBMs act as intermediaries between drug manufacturers, insurers, and pharmacies, negotiating drug prices and managing formularies for employer and government health plans. Lawmakers from both parties have increased scrutiny of PBM practices in recent years, holding hearings and proposing legislation focused on transparency, pricing structures, and market competition within the pharmaceutical supply chain according to KFF.
Pharmacists United for Truth and Transparency says Bryan Kiefer is a founding member of the Missouri Pharmacy Business Council and owns three independent pharmacies: Jones Drug Store, Twin City Pharmacy, and Chaffee Drug Store. The group says he has been instrumental in shaping legislation aimed at protecting local pharmacies and preserving healthcare access in those communities according to Pharmacists United for Truth & Transparency.
