Editorial: Mississippi Must Finish the Fight on PBM Reform
By Rep. John Faulkner
Mississippi stands at a pivotal moment in the ongoing national debate over prescription drug costs. While much of the attention has focused on pharmaceutical manufacturers, an equally powerful force operates behind the scenes: pharmacy benefit managers, or PBMs. These entities were originally created to control costs and manage prescription drug benefits, but many now question whether the system truly serves patients, pharmacists, and communities fairly.
Across the country in 2026, momentum continues to build for reform. At the federal level, policymakers are revisiting pricing strategies first introduced under President Donald Trump, including Most Favored Nation models aimed at lowering drug prices. At the same time, bipartisan legislation would require PBMs to operate under a fiduciary standard, meaning they must act in the best interest of patients and health plans, not simply their own financial interests.
While Washington debates, Mississippi has already stepped into the arena.
During the 2026 legislative session, PBM reform emerged as one of the most pressing and complex issues before lawmakers. Independent pharmacists from across the state delivered a consistent message: the current system is unsustainable. Many report reimbursement rates below the cost of medications, opaque pricing structures, and growing pressure from vertically integrated corporations that control multiple layers of the prescription drug supply chain.
Despite broad recognition that reform is needed, the Legislature failed to reach a final agreement before the session ended. That outcome, while disappointing, reflects the complexity of the issue and the high stakes involved.
Now, discussion is growing that the governor may call lawmakers back into a special session to continue work on PBM reform. If that happens, lawmakers must act with urgency and purpose.
The stakes are too high for delay.
Independent pharmacies are more than small businesses. In many Mississippi communities, particularly in rural areas, they serve as essential health care providers. They offer prescriptions, guidance, accessibility, and trusted relationships that larger, distant corporations often cannot replicate. In towns across the state, the local pharmacist remains one of the most accessible health care professionals for families.
When these pharmacies close, communities lose more than convenience. They lose access. Patients must travel longer distances, wait longer for medications, and sometimes go without needed care. For seniors, working families, and residents in underserved areas, these barriers can prove devastating.
At the center of this debate is vertical integration. When PBMs, insurance companies, and pharmacies operate under the same ownership or control, the playing field becomes uneven. This structure can enable patient steering, reimbursement practices that disadvantage independent pharmacies, and decisions that prioritize profit over care. It concentrates too much control in too few hands.
Other states are moving forward. Some are pushing for stronger transparency requirements so patients and providers can better understand how drug prices are set. Others are exploring limits on ownership structures to reduce conflicts of interest and restore fairness to the marketplace. Courts continue to weigh in as legislatures refine their approaches.
Mississippi should be part of that leadership.
Lawmakers need a balanced approach that promotes transparency, ensures fair reimbursement, and addresses conflicts of interest while preserving access to care. Reform should not pick winners and losers. It should create a system that works for patients first.
The inability to reach agreement during the regular session should not end the conversation. It should begin a renewed effort to get this right. If a special session is called, it offers a clear opportunity to finish the work and deliver meaningful reform for the people of this state.
The future of independent pharmacies and the communities that rely on them hangs in the balance. Mississippi has an opportunity to act with clarity, fairness, and purpose.
The path forward is clear. The only question that remains is whether the state will take it.
