Prescription drug prices do not become opaque by accident. They become opaque because the middlemen who manage drug benefits are allowed to hide many of their revenue streams from the employers, insurers, pharmacies, and patients who ultimately pay the bill. Congress has already recognized the problem. Federal pharmacy benefit manager (PBM) reporting requirements are scheduled to reshape what PBMs must disclose, but many of the most important provisions will not take effect until 2028. That delay creates a basic question for state lawmakers: why wait?
PBMs claim they lower prices by negotiating discounts. But without transparency, no one can verify whether those savings are being passed through to patients or quietly absorbed as revenue. This prevents insurers, employers, and other healthcare purchasers from effectively comparing PBMs when deciding who should manage their drug benefits. According to the Federal Trade Commission, it also allows PBMs to markup the costs of critical medicines such as cancer and HIV drugs.