The Biden administration's attempt to impose limits on pharmacy benefit managers (PBMs), tasked with negotiating drug prices, is facing criticism from pharmacists and independent drugstores.

The new rule, set to take effect on January 1, requires PBMs to take most of their "performance fees" when prescriptions are filled, aiming to address ballooning clawbacks amounting to $12.6 billion in 2021.

However, PBMs are responding by demanding contracts with significant payment cuts for drug dispensing, putting independent pharmacies at risk of losing Medicare customers to larger conglomerates. The unintended consequences include increased financial pressure, potential closures, and patient disruptions. Pharmacist groups, while supporting the rule change, did not anticipate the negative impact on independent pharmacies, resulting in challenges and walkouts among pharmacy staff.

The situation highlights the complexities of reforming the U.S. drug pricing system and its ripple effects on healthcare stakeholders.