BY EDWARD SHANSHALA
In rural New Hampshire, we take pride in knowing and caring for our neighbors. At Ammonoosuc Community Health Services (ACHS), our mission is rooted in that simple truth: health care should be accessible, affordable and compassionate for everyone, regardless of zip code or any other challenge you may face.
Every day, we watch patients make impossible choices: cutting pills in half, skipping refills, or walking away from the pharmacy counter because of prescription drug prices that make no sense. This isn’t just a policy failure; it’s a moral one. And the culprit here? PBMs.
Pharmacy Benefit Managers (PBMs) are the middlemen that sit between your doctor, your pharmacy, your health plan and you. Originally created to negotiate lower drug prices, they’ve quietly become some of the most powerful and opaque players in the entire health care system. They control which medicines are covered, where you can fill prescriptions and how much you pay out-of-pocket. In practice, they often drive up costs for patients, undermine independent pharmacies and extract enormous profits while providing patients with very little value.
The Federal Trade Commission confirmed as much in two recent reports, one just this past January. With four PBMs now controlling over 80% of the market, we’ve seen a system take shape that rewards complexity over clarity, and consolidation over competition. These companies demand large rebates from drug makers, favor expensive brand-name drugs over generics, and even require patients to use pharmacies they themselves own, marking up medications by thousands of percent in the process.
Let’s be clear: This is not sustainable, especially not for rural communities like here in Littleton and the surrounding area. Our patients, many of whom live with chronic conditions, rely on multiple prescriptions each month just to stay healthy, stay out of the emergency room and stay in the workforce. When out-of-pocket costs are based on inflated list prices instead of the real, negotiated prices behind the scenes, patients lose twice: first at the pharmacy counter, and again when rising premiums and taxpayer-funded programs pick up the rest.
A recent Wall Street Journal article captured this reality in stark detail, reporting that a new Senate investigation is underway into UnitedHealth Group’s Medicare billing practices, which stands as a powerful reminder of how the same conglomerates that own PBMs are now vertically integrated across insurance, pharmacy and provider networks. That’s not efficiency; it’s control.
Thankfully, Congress is paying attention. In February, the Senate Subcommittee on Healthcare restarted bipartisan efforts to reform PBMs. Several strong proposals are already on the table, including delinking PBM profits from drug prices, requiring rebates to be passed through to patients and protecting fair reimbursement for community pharmacies.
For rural health centers like ACHS, this work is personal. We’ve seen firsthand how local pharmacies struggle to stay afloat while giant PBMs dictate terms. We’ve seen patients ration medications because coinsurance is calculated on inflated prices. And we’ve seen how a system designed to promote competition now stifles it.
Last December, PBM reform came close to making it into the American Relief Act. This time, it must. The path is there. The bipartisan support is real. The need is urgent.
PBM reform presents the New Hampshire federal delegation with a genuine, bipartisan opportunity to lead on an issue that impacts every Granite State constituent, and insist that Congress takes this rare, actionable moment to fix a broken part of our healthcare system, and shift power back to the people who need it most: patients, providers and local pharmacists doing the hard work every day in our communities.
At ACHS, we’re proud to serve as part of the solution, and we’re ready to support action that puts patients first, restores fairness and makes prescription drugs truly affordable for all.
Edward D. Shanshala II is CEO of Ammonoosuc Community Health Services, Inc.
