As state lawmakers begin to return to office this week, a number of issues will be clamoring for their attention. One of the most important — but perhaps overlooked due to its technical and less attention-grabbing nature — is pharmacy benefit manager reform.

Reform-minded leaders should work with PBMs, leveraging their market power to achieve lower costs for consumers.

Last year, Arkansas became the first state in the nation to ban PBMs, and other states heavily regulated the industry. These efforts are expected to continue in 2026, even as courts raise constitutional questions about the Arkansas law and regulations in Iowa.

I’m a health care broker, so I know PBMs pretty well. They’re easy targets because of the complex process by which they work, as well as the pharmaceutical industry’s years-long campaign to put blame for drug pricing on the industry.

At its core, PBMs’ basic function is straightforward. Because they represent hundreds of thousands or even millions of patients who cannot negotiate with drugmakers on their own, PBMs are able to use their size as leverage to push for lower prices. When the big players reject a high price, a manufacturer has to decide whether it wants to lose access to those patients.

That negotiating leverage also keeps drugmakers from unilaterally dictating the cost of medications, from commonly used drugs like insulin to newer medications like Zepbound and Wegovy. For example, companies gave consumers a New Year’s present of increasing prices for 350 products — but the final costs to patients won’t be known until PBMs have their say.

U.S. health care pricing can be confusing, with even seasoned observers getting lost amid the jargon of rebates, formularies, and spread pricing. Critics often accuse PBMs of adding unnecessary layers of administrative cost or of exaggerating savings. Some of these concerns are legitimate, and the industry’s lack of transparency makes it easy for critics to portray PBMs as the villains keeping patients from being able to afford the medications they need.

But this criticism is better leveled at the drugmakers. They often insist they cannot lower prices because of research costs or regulatory burdens. Yet when Eli Lilly, the first trillion-dollar drug company, found itself boxed out of the CVS network, it suddenly found a way to make its products available more cheaply.

On December 1, drugmaker Eli Lilly cut the consumer cost of its popular weight-loss injection Zepbound, bringing its prices in line with competitor Novo Nordisk’s popular and recently reduced drug Wegovy.

Lilly’s move should be instructive for state and federal lawmakers because it came after Novo Nordisk agreed to lower prices of Wegovy under pressure from pharmacy giant CVS. CVS — through its PBM division, CVS Caremark — had initially tried to negotiate with Lilly, but the drugmaker refused to budge on its pricing, leading CVS Caremark to stop offering Zepbound to clients. But once Novo Nordisk agreed to reduce the price of Wegovy, Eli Lilly suddenly changed its tune.

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Photo by Justin Sullivan/Getty Images

Lawmakers looking to reduce prescription drug prices should take note.

Like all industries, PBMs have their flaws, but this case showed CVS forcing a needed price correction. And it should be front of mind for lawmakers who, yes, should insist on greater PBM transparency, but also must be aware of both the constitutional limitations on so-called “reforms” and how overregulating PBMs will impact constituents’ drug prices.

As lawmakers look for solutions to Americans’ record-high health care costs, they should realize that any cost-reduction effort must include prescriptions — and that means working with PBMs. Reform-minded leaders should work with PBMs, leveraging their market power to achieve lower costs for consumers while insisting on price transparency and other reforms that reinforce how PBMs are using fundamental market principles to keep drug companies from causing even more harm to Americans’ finances.

​Pbm reform, Pharmacy benefit managers, Gop, Legislative season, Healthcare costs, Drug prices, Pharmacy, Cvs, Opinion & analysis 

Two repeat offenders, a male and a female, have been charged with murdering an elderly woman in Houston earlier this week — and the male suspect reportedly was out on bond when he skipped a court appearance just days before the fatal shooting.

Tajuana Thomas, 38, and Richard Mouton, 34, are charged with capital murder in the shooting death of a 72-year-old woman, police said, adding that the shooting took place in the 4000 block of Lockwood Drive just before 2 a.m. Monday.

‘It’s always disturbing that you could be on parole, get a felony conviction, and still be on parole and not have your parole revoked.’

Officers responded to a report of a shooting at the residence and located three people suffering from gunshot wounds, police said, adding that responding Houston Fire Department paramedics pronounced the victim dead at the scene.

Thomas and Mouton were hospitalized, police said, adding that video shows they were involved in the shooting.

KPRC-TV, citing law enforcement sources, said witnesses told police that Thomas had been upset with the victim — identified in court records as Linda Martinez — because she previously refused to bail Thomas out of jail, and the two “argued about it all the time.”

Law enforcement sources also told the station that Thomas previously lived at the residence where the shooting took place, and the suspects entered the home through an unlocked back door.

Once inside, the suspects — who were wearing masks — allegedly found Martinez asleep on a couch, and sources told KPRC the pair demanded her jewelry while pointing an AR-style rifle at her.

The elderly victim apparently had plenty of fight in her.

RELATED: Violent repeat offender brutally beats up elderly whites, Mexicans in racially motivated attack, officials say

A law enforcement source told the station that Martinez used a revolver to shoot Mouton in the face and Thomas in the hip.

Court records also revealed criminal histories for both suspects, KPRC reported.

Thomas was on bond for misdemeanor terroristic threat, the station said, after a victim in 2022 reported that she had been fired from her job, showed up again, and allegedly told the victim she was going to “beat his ass.”

More from KPRC:

Mouton, a convicted felon, was on parole until 2024, according to court records.

Then in July of 2025, Mouton got arrested for three charges in Harris County: drug possession, felon in possession of a weapon, and evading arrest.

In those cases, he allegedly ran nearly 1,500 feet from a traffic stop while possessing more than 100 grams of marijuana, 5 grams of ecstasy, 11.7 grams of Xanax, 24+ grams of methamphetamine, 3.4 grams of cocaine, and a firearm, according to records.

RELATED: 9-time convicted felon opens fire on man, woman outside Florida home; he allegedly was after money owed to him: Cops

The station said Mouton was released on bond shortly after his July arrest — but added that records indicate he didn’t show up for a court date last week, after which warrants for Mouton’s arrest were filed, KPRC said.

Mouton reportedly skipped court on Jan. 22; Martinez was killed on Jan. 26.

“It’s always disturbing that you could be on parole, get a felony conviction, and still be on parole and not have your parole revoked,” Andy Kahan with Crime Stoppers told KRIV-TV.

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​Homeowner shoots intruders, Homeowner fatally shot, Capital murder charges, Houston, Elderly woman victim, Home invasion, Repeat offenders, Skipping court, On bond, Crime