PBM Reform and Pharma Tariffs Could Pull Drug Affordability in Opposite Directions

America is trying to accomplish several difficult healthcare goals at the same time: lower prescription drug costs, increase pharmacy benefit manager (PBM) transparency, strengthen domestic pharmaceutical manufacturing, and protect the drug supply chain. Each objective is defensible on its own. The challenge is making sure policies designed to achieve one goal do not undermine another.

That tension is becoming increasingly important for Alabama. According to 2026 employer coverage data, approximately 2.35 million Alabamians receive health insurance through an employer, with 59% of that coverage provided through self-funded plans. For a self-funded employer covering hundreds or thousands of members, even modest increases in prescription costs can quickly translate into higher plan spending, greater employee cost sharing, or pressure to reduce benefits elsewhere.