A New Era for Pharmacy: States Advance Legislation to Curb PBM Power and Expand Pharmacist Roles

Across the United States, states are witnessing a surge of legislative momentum aimed at modernizing pharmacy practice. Two distinct but equally significant trends are emerging: states are cracking down on predatory pharmacy benefit manager (PBM) practices to protect independent pharmacies, and others are proactively expanding pharmacists’ clinical authority to address critical public health needs. These legislative efforts signify a growing recognition of pharmacists as essential, accessible healthcare providers.

PBM Reforms: Protecting Community Pharmacies from Financial Strain

In a major victory for independent pharmacies, Alabama’s lawmakers unanimously passed legislation in April 2025 requiring PBMs to reimburse pharmacies at no less than the state’s Medicaid rate for prescription fills. The bill, which was signed into law by Governor Kay Ivey, also outright bans spread pricing—a practice where PBMs charge insurers more for a drug than they pay the pharmacy, pocketing the difference.

This landmark law directly addresses the primary cause of community pharmacy closures: unsustainably low PBM reimbursement rates that often fall below the pharmacy’s cost of dispensing a prescription. By guaranteeing a fair, cost-based payment, the legislation aims to stabilize the finances of independent and rural pharmacies, which are vital lifelines in underserved communities. The law’s provisions for spread pricing transparency will also limit hidden margins and introduce greater accountability into the PBM market. With similar legislation gaining traction in other states, Alabama’s new law could serve as a powerful model for a nationwide movement to curb PBM abuses.

Expanding Pharmacist Authority: The Nevada Model

While Alabama’s focus is on financial stability, other states are leading the charge on expanding the scope of pharmacy practice. Nevada, a pioneer in this movement, passed two forward-looking laws in 2021—SB 325 and SB 190—that continue to serve as a national model.

HIV Prevention: SB 325 empowers pharmacists to prescribe, dispense, and administer HIV prevention medications like preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) without a prior prescription from a physician. To ensure patient safety, the law requires pharmacists to complete accredited training, assess crucial lab values (such as HIV status and renal function), and adhere to detailed counseling protocols. It also mandates that state-regulated insurers cover both the medication and the pharmacist’s service.
Contraceptive Access: SB 190 complements this by allowing pharmacists to dispense self-administered hormonal contraceptives under statewide protocols. Similar to the HIV prevention law, it requires specialized pharmacist training and patient screening, while ensuring insurance coverage for the pharmacist-provided service.

By addressing critical public health needs and increasing access to preventive care, particularly in a state with high HIV diagnosis rates, Nevada’s model demonstrates how pharmacists can fill crucial gaps in the healthcare system. The integration of training, protocols, and insurance coverage in these laws provides a blueprint for other states facing similar challenges with provider shortages.

National Trends and Future Outlook

The legislative activity in Alabama and Nevada are part of a much larger national trend. As of mid-2025, lawmakers in 44 states have introduced 211 bills aimed at expanding pharmacists’ roles and securing appropriate reimbursement. These proposals are addressing critical priorities, including:

Vaccination Authority: Granting pharmacists the authority to administer all vaccines recommended by the CDC.
Test-and-Treat Programs: Empowering pharmacists to diagnose and treat common illnesses like influenza, strep throat, and COVID-19, especially in rural and underserved areas.
Payment Mechanisms: Tying expanded authority directly to reimbursement from public and private payers, ensuring pharmacists are fairly compensated for their new services.

While only a fraction of these bills (16 in 12 states) have been signed into law so far in 2025, the sheer volume of proposed legislation indicates a powerful, national recognition of pharmacists as accessible healthcare providers. The progress in states like Alabama and Nevada showcases two key pillars of a stronger, more resilient pharmacy profession.