Los Angeles – October 01, 2026 -- Three pharmacy benefit managers—CVS Caremark, Optum Rx, and Express Scripts—processed roughly 80% of U.S. prescription claims last year, a concentration that AlignRx says is squeezing independent pharmacies out of the market. The nation's largest independently owned Pharmacy Services Administrative Organization (PSAO) is the subject of a forthcoming feature on the public television series All Access with Andy Garcia, which examines the reimbursement pressures facing community pharmacies nationwide.
Vertically integrated PBMs leave pharmacies reimbursed below drug cost
The feature details how market consolidation among the three dominant PBMs has created a vertically integrated system in which patients face higher out-of-pocket costs and reduced choice. Community pharmacies, AlignRx says, are often reimbursed less than the cost of the medication they dispense, straining their ability to stay open.
AlignRx operates as the only PSAO structured as a Public Benefit LLC
Founded in 2021, AlignRx works with community pharmacies across all 50 states and Puerto Rico, representing nearly 5,300 pharmacies. It is the only PSAO organized as a Public Benefit LLC, a structure the company says ties its mission directly to advocacy for transparency, fair competition, pharmacy choice and patient access. Under its model, each pharmacy retains the ability to select its own wholesaler or buying group.
Research links PBM consolidation to pharmacy closures in Medicaid and Medicare communities
Research cited in the feature shows pharmacies serving areas with higher concentrations of Medicaid and Medicare patients have closed at greater rates than others, contributing to the spread of pharmacy deserts in both rural counties and urban neighborhoods. AlignRx president Melanie Maxwell frames the dynamic as a modern-day "David and Goliath" struggle between independent pharmacies and dominant industry players.
"The relationship across the patient, the physician, and the pharmacist is like a three-legged stool,