Pharmacy benefit manager policy and pharmacy stakeholder perceptions of financial pressures and closures.

INTRODUCTION: The community pharmacy workforce provides access to medications and services, yet financial pressures and pharmacy closures threaten patient access. Pharmacy benefit managers (PBMs) influence medication reimbursement and are frequently cited as contributors to financial strain. States have enacted legislation to regulate PBM practices. This study examined state PBM laws from 2015 to 2025 and pharmacy stakeholder and workforce perceptions of factors influencing closures. METHODS: Enacted state PBM legislation from 2015 to 2025 was identified using the National Academy for State Health Policy and the National Conference of State Legislatures databases and analyzed descriptively. Thirteen key informant interviews were conducted with pharmacy organization leaders and pharmacists with firsthand closure experience. Interviews focused on system-level contributors to closures and were analyzed using rapid content analysis. RESULTS: Pharmacy benefit manager regulation expanded from 2 states in 2015 to all 50 states by 2023. Interview participants perceived PBM practices as a major contributor to financial instability and low workforce morale. While PBM policies were viewed as necessary, participants cited inconsistent enforcement and limited workforce relief. CONCLUSION: Despite regulations, PBM practices are perceived as key drivers of financial pressures and closures. Strengthening policy implementation and enforcement may help sustain the workforce and preserve access to care.