AIPA: Blue Cross Blue Shield of AL response letter

December 23, 2025

In the face of significant premium hikes, coverage denials and ailing hospitals, calls for transparency of health insurers in Alabama are steadily increasing in volume and consistency. Alabama Independent Pharmacy Alliance (AIPA) supports these calls for transparency in the name of fair pay rates for healthcare providers and low costs for consumers and taxpayers.

Since its inception, AIPA has advocated for transparency of pharmacy benefit manager (PBM) practices that have closed hundreds of  local pharmacies nationally and inflated drug costs for citizens. The PBM middleman siphons an undisclosed amount of value from the interaction between an insured individual and his or her pharmacy. To protect this arrangement, PBMs fight tooth and nail to avoid any scrutiny or transparency.

The threats facing pharmacies are an illustration of the threat to all healthcare providers in Alabama. Health insurance companies are the middleman between citizens and their doctors, dentists and other providers. As premiums and deductibles rise and care is denied by insurers, citizens are asking reasonable questions that deserve answers:

“How much of my money is being kept by the insurance company and why?  How are my dollars used?”

“Why is my doctor being paid at low rates while insurance executives seem to be paid very well?”

“What value is the insurance company actually providing as my costs increase?”

In Alabama, answers to questions such as these are impossible to obtain because insurance companies can hide behind an opaque veil provided by a 2015 state law. Alabama’s health insurance market is dominated by one company, leaving consumers little to no choice when buying insurance.  That company is nonprofit, yet it has no duty to disclose salaries or other financial information to the public. This arrangement raises legitimate questions about whether conflicts of interest exist.

For example, Prime Therapeutics, a PBM and a for-profit corporation, is privately held by a group of Blue Cross Blue Shield plans including Blue Cross Blue Shield of Alabama (BC/BS AL). BC/BS AL’s dominance of the marketplace makes it possible for the nonprofit to funnel business to the for-profit corporation that it owns. The profits from this arrangement are intended to lower premiums for consumers, but BC/BS AL does not have to disclose if or how those profits were used for that purpose. 

A larger question arises: what proportion of the taxpayer dollars that are intended for teachers’ and state and local employees’ health benefits is spent on the actual benefit, and what proportion goes to insurance company salaries and bonuses?

Alabama’s legislature and Department of Insurance have heard the concerns of pharmacies and have acted in the last year, to the benefit of local businesses and patients.  AIPA urges further transparency of PBMs and of health insurers. The citizens who foot the bill deserve answers to their questions.

Alabama Independent Pharmacy Alliance (AIPA) is a volunteer organization comprised of local pharmacy owners, pharmacists and staff, dedicated to preserving and forwarding the practice of independent pharmacy in the state of Alabama.

www.aiparx.com Media inquiries: media@aiparx.com