SHARx: Why PBM Reform Needs an Employer Scorecard

While legislative efforts to curb PBM practices have emerged across all 50 states, the sheer number of bills introduced often masks a lack of tangible results for the self-funded plans that ultimately foot the bill. Paul Pruitt, Chief Growth Officer at SHARx, argues that pressure on PBMs does not equate to progress if the underlying friction in the prescription drug market remains unchanged. Even with federal mandates like the Consolidated Appropriations Act of 2026—which requires the pass-through of rebates and fees—Pruitt warns that compensation can be easily relabeled or obscured through affiliated entities without rigorous, independent auditing.

Recent legal battles, such as the challenge to Arkansas’s law barring PBM-owned pharmacies and Florida’s subpoenas targeting CVS Health, highlight the complexity of the current regulatory landscape. However, these disputes often prioritize profit allocation over the needs of the patient. For employers navigating these shifting policies, the critical questions remain whether a new law alters net-cost exposure or simply shifts who collects the profit. Until reform initiatives focus on measurable outcomes—such as reduced administrative barriers and expanded pharmacy choice—they risk failing the very employers they are intended to protect.