A bipartisan majority of state attorneys general support ongoing efforts in Congress to reform the practices of pharmacy benefit managers.

"A small number of PBMs hold significant market power and are reaping abundant profits at the expense of the patients, employers and government payors the PBMs are supposed to help," according to a letter from 39 attorneys general to congressional leaders. ""Pharmaceutical buyers and sellers have little choice but to employ PBMs, allowing them to extract both monopoly profits from individuals and monopsony profits from the market. Moreover, PBMs often dictate reimbursement rates and rules to independent pharmacies, making it difficult for many to survive."