By Jeanette Hoffman, Executive Director, Patients Come First New Jersey

For years, New Jersey lawmakers have heard the same message from independent pharmacists, patients, employers, and healthcare advocates: Pharmacy Benefit Managers (PBMs) wield enormous power over prescription drug pricing, often at the expense of the very people our healthcare system is supposed to serve.

Yet, despite consensus from Governor Sherrill and lawmakers that reform is urgently needed, meaningful legislation has once again stalled in the New Jersey Legislature.

That needs to change.

When the Legislature returns in the fall to tackle affordability issues, PBM reform should be among its highest priorities. Because of these companies' monopolistic behavior, healthcare costs continue to climb and patients face unncessary barriers to accessing their medications.

PBMs were originally created to help manage prescription drug benefits and negotiate lower prices. Today, however, the industry has become increasingly opaque. According to a report by the Federal Trade Commission (FTC), three large PBMs now control over 80 percent of the prescription drug market, giving them extraordinary influence over which medications patients receive, what pharmacies they can use, and how much pharmacists are reimbursed.

Independent pharmacies are bearing the brunt of this imbalance. In fact, locally-owned pharmacies have reported being reimbursed below the cost of acquiring medications, leaving them to lose money simply by filling prescriptions. Many have been forced to reduce services, lay off staff, or close altogether.

When a community pharmacy disappears, the consequences extend far beyond a storefront. Seniors lose trusted healthcare professionals who know their medical histories. Rural and underserved communities lose convenient access to medications. Patients with chronic illnesses lose an advocate who helps manage complex treatment plans. The result is poorer health outcomes and higher healthcare costs for everyone.

Patients also pay the price through confusing formularies, frequent prior authorization requirements, and limited pharmacy choices. Too often, decisions about patient care are driven by “black box” financial arrangements hidden from public view rather than what is medically appropriate.

For example, on July 1, 2026, New Jersey state employees were alerted to the fact that prescriptions designated as “maintenance medications” are required to be filled by mail at Optum Home Delivery, or they would not be covered. Once again, PBMs limit patient choice and manipulate the pharmacy marketplace.

Unfortunately, despite strong support from patients, pharmacists, healthcare providers, and small business advocates, PBM reform legislation has stalled in the New Jersey Senate. While discussions continue, independent pharmacies continue to close and patients continue to face unnecessary obstacles to affordable medications.

Comprehensive, bipartisan PBM reform legislation would increase transparency, establish fair reimbursement standards, prohibit abusive business practices, and provide stronger oversight of an industry that has operated with too little accountability for too long. Similar reforms have been enacted in numerous states across the country, demonstrating that meaningful oversight is both achievable and effective.

This is not a partisan issue. Prescription drug affordability affects Republicans, Democrats, and Independents alike. New Jersey families, employers, and pharmacies all have a stake in getting this right.

Moreover, New Jersey has long prided itself on supporting small businesses and protecting consumers. PBM reform advances both goals. It promotes transparency in a marketplace that desperately needs it, while helping preserve the local pharmacies that serve as vital healthcare providers in communities throughout the state.

This fall, the Legislature has an opportunity to move PBM reform legislation without further delay and send it to the Governor’s desk.

New Jersey patients deserve nothing less than access, affordability, and transparency.