AIPA: Open letter for November

November 25, 2025

Thanksgiving Day is approaching, a time to reflect on our blessings, good fortune and the good people in our lives.  The Alabama Independent Pharmacy Alliance (AIPA) is particularly thankful for the efforts of the legislators who heard pharmacies’ concerns and acted in the last session by unanimously passing SB252, the Community Pharmacy Relief Act, and for the Alabama Department of Insurance Pharmacy Benefit Manager Compliance Division (PBM Division), which is tasked with enforcing the provisions of the new law.  The staff at the PBM Division are working long hours to ensure that the intent of the law is enforced.

The PBM Division’s efforts have begun to bear fruit.  Smaller Pharmacy Benefit Managers (PBMs) have begun to respond to filed complaints and have in some cases corrected prescription claims that were initially paid below the amounts required by the law.  Small pharmacies in Alabama are grateful to the PBM Division for their diligence.

However, the three largest PBMs, which are each subsidiaries of multi-billion dollar Fortune 15 companies, have evidently been slowest to respond.  At least one of those PBMs has taken the position that their company is in many cases exempt from the provisions of SB252 because they represent clients that are geographically situated outside of Alabama.  The provisions of SB252 provide no such exemption: there is no language in the law predicating its provisions upon where a PBM or its client is domiciled, and the law addresses PBMs that operate within Alabama.

The large PBMs have played this hand before.  The Kentucky legislature overwhelmingly passed Senate Bill 188 in 2024, a bill with provisions that aimed to curb PBM abuses similarly to Alabama’s SB252.  Large PBMs made the same argument in Kentucky, prompting the bill’s sponsor to request an opinion from their state’s Attorney General.  The Attorney General concurred with the law’s intent in an opinion published on September 24, 2025, concluding that a PBM operating in the state was beholden to the law, regardless of its location, the location of its client.

It is the position of AIPA that the multi-billion dollar PBMs are betting on their wealth and sheer size to sustain them in a standoff with Alabama’s regulators and legislators.  At the volume of claims processed by these companies in Alabama, any delay in proper pay to pharmacy providers amounts to a significant, interest-free loan to these giant companies provided at the expense of our community pharmacies that care for the people of Alabama.

Alabama’s independent pharmacies are indeed grateful for the short term relief of the “Band-Aid” that is SB252.  In order to restore the pharmacy profession and patient care in our state, there is still much work to be done.

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