October 28, 2025
NFIB has advocated for reforming the PBM industry
Small business owners have routinely ranked the cost of health insurance as the most severe problem for their small businesses for over four decades. NFIB continues to advocate for legislation that would help ease this burden on small employers at both the federal and state levels.
Pharmacy Benefit Managers (PBMs) are third-party middlemen that negotiate drug prices and benefits for insurers and employers. The PBM market is highly concentrated, with the top three PBMs (Caremark, Express Scripts, and OptumRX) controlling 80% of the market.
State Representative Julie McGuire recently wrote an op-ed in the Indianapolis Business Journal explaining what Indiana small business owners should do to help lower health care costs:
- Audit your PBM contracts annually – Indiana law allows you to audit your PBM’s pricing practices.
- Demand full claims transparency and require access to your plan’s claims data.
- Engage independent experts.
- Support legislative reform.
- Educate your workforce on the impact of PBMs.
Read Rep. McGuire’s article here to learn more information.
Take Action: The lack of competition in the PBM industry has led to higher prices and fewer choices for small business owners. Tell your elected officials to prioritize PBM reform.
NFIB is a member-driven organization advocating on behalf of small and independent businesses nationwide.
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