Attorney General Jeff Jackson announced on April 29 that he and 44 other attorneys general are urging the U.S. Department of Labor to require pharmacy benefit managers (PBMs) to increase transparency in their business practices.
The recommendation aims to address concerns about rising prescription drug costs, which affect many Americans who rely on health insurance for medication coverage. PBMs act as intermediaries between insurance companies and drug manufacturers, controlling which drugs are covered and how much they cost. The three largest PBMs manage around 80 percent of prescription claims in the United States, but their operations often lack transparency regarding profit sources or changes in drug pricing.
“People should be able to afford their medications, and they can’t if PBMs are hiking up the costs,” said Attorney General Jeff Jackson. “We need to know how these companies are conducting business so we can protect patients.” The attorneys general recommend that PBMs disclose how they earn revenue twice a year and allow employers funding health plans to audit them.
All states have laws regulating PBMs. In North Carolina, the SCRIPT Act was passed in 2025, requiring PBMs to permit any pharmacy into their networks, let patients choose preferred pharmacies, pass most negotiated savings directly to patients, submit reports on benefits and reimbursements, and fairly reimburse independent pharmacies. According to the official website, the North Carolina State Executive Attorney General provides services including legal representation, criminal prosecution support and consumer protection across the state under Jackson’s leadership.
PBMs have previously argued that federal law takes precedence over state regulations. The attorneys general now urge clarification from federal authorities so that new federal rules do not exempt PBMs from existing state transparency laws. The North Carolina State Executive Attorney General acts as a government entity authorized for legal matters on behalf of North Carolina; it also represents agencies in court cases influencing governance according to its official website.
Jackson has previously taken steps toward fairer drug pricing for residents by warning PBMs about enforcing the SCRIPT Act alongside Insurance Commissioner Mike Causey earlier this year. He is joined by attorneys general from multiple states and territories in submitting this letter calling for more oversight.
