In Pennsylvania’s rural communities, access to health care is a lifeline. For many, local pharmacies are among the few trusted medical resources available nearby, providing essential …
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In Pennsylvania’s rural communities, access to health care is a lifeline. For many, local pharmacies are among the few trusted medical resources available nearby, providing essential medications and health advice.
However, rising medication costs and complex pharmacy benefit manager (PBM) practices are making it harder for rural residents to afford the prescriptions they need.
PBMs—middlemen who were originally meant to reduce drug costs—now seem more focused on profits than on ensuring patients have affordable access to medications. Therefore the Pennsylvania State Grange supports swift federal action to bring accountability to PBMs and protect the health of rural Americans.
As a seventh-generation dairy farmer and leader of the Pennsylvania State Grange, I see firsthand how critical affordable health care is to our communities. The Grange has a long-standing commitment to advocating for the needs of rural families, small businesses and farmers, and access to health care remains one of our top priorities. For the nearly 5,500 members we represent across the commonwealth, rising prescription costs are more than an inconvenience—they threaten the well-being and financial stability of families who already face numerous challenges unique to rural life.
PBMs were intended to negotiate better drug prices, but today they operate with little oversight, often adding costs rather than reducing them. These middlemen determine which drugs are covered, impose hefty fees on local pharmacies, and engage in complex rebate practices that rarely benefit consumers. It’s all too common for PBMs to pocket savings from drug price negotiations, leaving patients and rural families to bear the brunt of inflated prices. As a result, many people in our communities are forced to choose between buying groceries and paying for essential prescriptions—a choice no one should have to make.
One of the most troubling aspects of current PBM practices is how they restrict patients’ pharmacy options. Many PBMs force patients to use preferred or mail-order pharmacies, often located far from their homes, instead of local pharmacies that know and support the community. This practice not only inconveniences rural residents but also hurts small-town pharmacies that provide critical services and fill a vital role in the community. In some areas, losing a pharmacy means losing a primary health care resource, further isolating rural communities from the health care support they need.
While Pennsylvania and other states have begun to tackle PBM transparency and accountability, we need federal legislation to ensure that these middlemen operate with fairness across the nation. Congress has an opportunity to act now to protect patients and restore a sense of integrity to the health care system. This isn’t just an issue for cities or suburbs; it is a national concern, one that affects families and small businesses everywhere every day.
At the Pennsylvania State Grange, our mission has always been to support and uplift rural communities, whether through education, community service or advocacy. PBM reform aligns perfectly with our values, as it ensures that health care access and affordability are prioritized over the profit motives of powerful intermediaries. Rural Americans and farmers deserve a health care system that works for them, not against them.
The health of our communities and future generations depends on our leaders taking a stand against unchecked PBM practices. Now is the time for Congress to bring transparency and fairness to the prescription drug supply chain. For the Grange, for our families, and for all Americans, we urge you to act now—not later—on PBM reform. Let’s protect rural health care and ensure that every Pennsylvanian has access to the medicines they need.
Matthew Espenshade is the president of the Pennsylvania State Grange.
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