For too long, New Jersey patients have been caught in the middle of a broken prescription drug system — one where costs are rising, access is inconsistent and transparency is virtually nonexistent.
At the center of this dysfunction are pharmacy benefit managers, or PBMs, powerful supply-chain middlemen that were intended to help manage drug costs, but now often do the opposite.
Gov. Mikie Sherrill deserves credit for making PBM reform a priority in her inaugural budget. By elevating this issue, she has sent a clear message: Patients, not middlemen, must come first.
PBMs play an outsized role in determining which medications patients can access, what they pay at the pharmacy counter and which pharmacies can participate in their networks. Yet their operations remain largely opaque. Patients and providers alike are left in the dark about how decisions are made, how rebates are negotiated and where the money ultimately goes.
The six largest PBMs manage almost 95% of prescriptions filled in the United States, according to a 2024 report by the Federal Trade Commission.
This concentrated market structure allows benefit managers to profit at the expense of patients and independent pharmacists, the report found. Patients are routinely forced to switch medications for non-medical reasons. Independent pharmacies, often a backbone of local communities, are squeezed by unfair reimbursement practices. And employers and taxpayers continue to shoulder rising costs without a clear understanding of why.
Reforming pharmacy benefit managers is not about disrupting the system for the sake of it. Rather, it’s about restoring balance, accountability and fairness. Common-sense reforms can make a meaningful difference. These include requiring greater transparency into rebate practices; ensuring that savings are passed directly to patients; prohibiting spread pricing in Medicaid; and protecting patient access to their pharmacy of choice.
Importantly, PBM reform is one of the most effective ways to lower drug costs without undermining innovation. Unlike blunt policy tools such as price controls, which risk limiting research and development, PBM reform targets inefficiencies and misaligned incentives within the system. It focuses on eliminating waste, not inhibiting access to future cures.
For patients managing chronic conditions, for seniors on fixed incomes and for families stretched thin, this issue is not abstract. It is deeply personal. Every unnecessary dollar spent at the pharmacy counter is a burden. Every delay in accessing needed medication is a risk.
Other states have begun to take action, recognizing that unchecked PBM practices are unsustainable. New Jersey now has an opportunity to lead, and Sherrill’s commitment signals that the state is ready to do just that. Now, it is up to the Legislature — with less than a month to pass the fiscal 2027 budget — to build on that momentum and deliver meaningful reform.
New Jersey patients have waited long enough. The time to act is now.
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