SHARx Calls for Accountability as Policymakers Target PBM Practices Nationwide

Rising drug costs and persistent access barriers are prompting employers to scrutinize the role of PBMs in determining how care is delivered. SHARx is drawing attention to how these intermediaries influence both spending and whether patients receive prescribed medications.

ST. LOUIS, May 18, 2026 /PRNewswire/ -- As lawmakers intensify efforts to rein in prescription drug costs, employers across the U.S. are confronting a deeper and more urgent problem: they are funding a system they cannot see, audit, or control, while employees still struggle to access the medications they need.

"Employers are paying for a system they don't control, and it's one that often blocks the very care they're trying to provide," said Paul Pruitt, Chief Growth Officer and co-founder of SHARx. "We've created a structure where the people funding healthcare have the least visibility, and the people needing care have the least certainty of getting it."

Pharmacy Benefit Managers (PBMs), which control all prescription drug claims nationwide, sit at the center of that system, dictating pricing, coverage, and access decisions with limited transparency to the employers who pay for it, according to the Kaiser Family Foundation.

SHARx, a procurement management solution for high-cost prescription drugs, highlights the growing disconnect at the center of the PBM model. Employers pay the bill for rising drug costs, yet powerful PBM intermediaries control access by designing formularies, managing pharmacy networks, and imposing utilization controls such as prior authorization and step therapy. In practice, these third parties often decide whether patients receive the treatments their physicians prescribe, as outlined in analyses of PBM practices by Cancer Therapy Advisor and KFF.

Employers Carry the Cost; PBMs Control Outcomes

Recent policy developments reported in STAT underscore the scale of the issue. Federal lawmakers and regulators are advancing reforms that would impose fiduciary responsibilities on PBMs, requiring them to act in the best interests of employers and patients rather than their own financial gain. These proposals reflect mounting concern that PBMs have historically operated with misaligned incentives, prioritizing rebate structures and internal revenue streams over affordability and access. At the same time, state-level efforts to regulate PBM practices are facing legal challenges that threaten to slow or weaken reform, leaving many of the system's core issues unresolved, according to Axios reporting.

Meanwhile, courts are slowing state-level reform efforts, creating a fragmented regulatory landscape that leaves many systemic issues unresolved.

PBMs sit at the center of the prescription drug supply chain, influencing pricing, formulary placement, pharmacy networks, and reimbursement. While reforms are beginning to target transparency and rebate practices, employers still lack meaningful insight into how decisions are made or why costs continue to escalate.

Federal action reported in KFF and STAT shows how new disclosure requirements and increased oversight tied to employer health plans are being viewed by policymakers and industry observers as a shift in PBM accountability. However, while these requirements address greater transparency and auditability in financial flows, they do not address the utilization of controls that determine patient access.

"Even with reform, employers are still underwriting a system where someone else controls the outcome," Pruitt said. "That's not just inefficient; it's fundamentally broken."

Lower Prices Don't Equal Access

Despite policy momentum around drug pricing, employees continue to face significant barriers to care. Prior authorization delays, step therapy requirements, formulary exclusions, and restricted pharmacy networks remain standard practice across PBM-managed plans.

One SHARx member described spending months fighting her insurance company through repeated denials after her daughter was removed from the medication that had successfully managed a serious autoimmune disease. Despite extensive medical documentation and appeals, access to the prescribed treatment continued to be blocked, resulting in worsening symptoms, disruption to daily life, and emotional strain on the entire family.

"Even with every piece of evidence provided, we kept receiving only a 'no,'" the member shared. "After months of delays and repeated denials, barriers continued to keep our daughter from the medication her doctor prescribed. The same medication that had changed the course of her lifelong disease. We were beyond words, broken, watching her health decline while waiting for access to the care she needed."

These barriers persist even as policymakers attempt to reshape the financial structure of the system. Recent federal reforms have targeted practices like spread pricing and rebate retention, but experts note that these changes alone will not resolve broader access challenges. 

"After months of delays and repeated denials, SHARx pushed through barriers that had kept our daughter from the medication her doctor prescribed. Their dedication means she can now move forward with hope and a renewed sense of normalcy," the member stated in an email to the company.

"Washington is focused on price, but patients are dealing with access," Pruitt added. "If someone can't get the medication their doctor prescribed, it doesn't matter what the spreadsheet says the price is."

Legal and Political Pressure Mounts

Across the country, PBMs are facing increased scrutiny from both federal and state governments. While dozens of states have attempted to pass laws regulating PBM practices, legal challenges are limiting their effectiveness and slowing implementation, according to Axios reporting.

Meanwhile, bipartisan federal efforts, including proposals like the FAIR Act, seek to fundamentally reshape the PBM model by imposing fiduciary obligations and increasing accountability to employers and patients. 

Healthcare analysts note that these reforms could mark a significant shift in how PBMs operate, but caution that structural change will take time and may face resistance from entrenched industry players.

Employees Caught in the Middle

The consequences of this system are increasingly visible in the workplace. Employees rely on employer-sponsored insurance for access to care, yet many face delays, denials, or high out-of-pocket costs for necessary medications.

As employers attempt to manage rising pharmacy spend, cost pressures are often passed downstream, impacting employee satisfaction, retention, and trust in benefits programs.

"What we're seeing is a complete misalignment," Pruitt said. "Employers are paying more, employees are getting less, and the system in the middle is profiting from the gap."

A Breaking Point and Shift in Strategy

Faced with escalating costs and limited control, employers are beginning to rethink prescription benefits as a procurement and supply chain challenge rather than a traditional insurance function.

Forward-looking organizations are:

• Demanding transparent, pass-through pricing models
• Exploring alternative sourcing strategies for specialty drugs
• Separating pharmacy benefits from traditional PBM structures
• Seeking partners that prioritize both cost control and patient access

"This is no longer an HR issue; it's a business risk issue," Pruitt said. "When pharmacy spend becomes unpredictable and uncontrollable, it rises to the level of financial governance."

Access and Accountability in Focus

SHARx is part of a growing movement to realign incentives in the prescription drug market. By combining transparent pricing with hands-on patient advocacy, SHARx helps employers reduce costs while actively navigating access barriers for employees.

"Our model is simple," said Pruitt. "Employers should know what they're paying for, patients should get the medications they need without obstruction, and clinical decisions should stay where they belong, between doctors and patients."

As PBM reform accelerates, SHARx is urging policymakers, employers, and healthcare leaders to expand the conversation beyond pricing and address the structural barriers that continue to limit access to care.

"Until we fix who controls access, not just who is setting prices, we're going to keep seeing the same failures," Pruitt said. "Employers are waking up, and they're not going to keep writing blank checks for a system that doesn't work."

About SHARx
SHARx was founded to fight back against the broken system of overpriced prescription drugs. Industry pioneers Corey Durbin and Paul Pruitt built SHARx to put people before profits. With an innovative and ethical sourcing model, SHARx cuts through the waste with radical transparency, common-sense cost containment, and a member-first approach. No hidden markups. No games. Just the meds people need, delivered affordably, reliably, and with dignity. A growing list of notable sports voices, including Sophie Cunningham, standout guard for the WNBA Indiana Fever, Brock Osweiler, former NFL quarterback and college football analyst for ESPN, and Heath Shuler, former NFL quarterback and SEC Player of the Year, are helping amplify SHARx's fight to restore financial equity to a broken healthcare system. Learn more at SHARXplan.com 

Sources:

1. Sood, N. (2026, March 30). To lower drug prices, give PBMs a fiduciary duty to patients. STAT.
2. Kaiser Family Foundation. (2026). What to know about pharmacy benefit managers (PBMs) and federal efforts at regulation.
3. Cancer Therapy Advisor. (2026). What is a pharmacy benefit manager (PBM)?
4. Axios. (2026, April 15). States' efforts to rein in PBMs hit a legal roadblock.
5. Modern Healthcare. (2026). Blue Shield of California PBM strategy 

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SOURCE SHARx