In a small household in Elizabethton, Tennessee, a married couple has managed to bridge one of the deepest divides in modern American life. Amye and Charlie Joseph have been together for 35 years, but they sit on opposite ends of the political spectrum. She is a Republican; he is a Democrat. Yet, in a political climate defined by gridlock and acrimony, the couple has discovered a shared enemy: pharmacy benefit managers.
Amye Joseph describes the current moment as an "interesting time" to be in a mixed-political marriage. But whatever disagreements they may have about elections or policy, they are firmly united in their frustration with the healthcare industry. Their discontent centers specifically on PBMs, the little-understood corporate intermediaries that negotiate prescription drug prices on behalf of insurers, employers, and government programs.
"My husband and I don't agree on much politically," Joseph said, echoing a sentiment that is increasingly common across the country. "But we both agree that the system is rigged against us." Their specific ire is directed at CVS Health, a corporate conglomerate that reported a staggering $400 billion in revenue last year. CVS Health owns Aetna, a major health insurance provider; CVS Caremark, one of the nation's dominant pharmacy benefit managers; and CVS Pharmacy, the largest retail pharmacy chain in the United States.
This vertically integrated structure, critics argue, creates a conflict of interest that allows the company to profit at multiple points in the healthcare supply chain. Joseph says she and her husband "hate CVS," describing the company as a "money grab" rather than a legitimate middleman. They lament the loss of face-to-face interaction with local pharmacists, the inexplicable rise in drug prices, and the pressure they feel from their CVS Caremark drug plan to fill prescriptions at CVS stores rather than at independent local pharmacies.
PBMs were originally conceived as a solution to a complex problem. In theory, they would act as bulk purchasers, using their negotiating power to hold down drug costs for employers and patients. Over time, however, these middlemen have accumulated significant power and been accused of prioritizing their own profits over the interests of the people they are supposed to serve. The resulting frustration has turned PBMs into what political observers now call a bipartisan punching bag.
The scope of the backlash is remarkable given how polarized American politics has become. In Washington, D.C., Democrats and Republicans continue to clash over major healthcare policy questions. Yet taking on pharmacy benefit managers has emerged as a rare unifying cause, driven by widespread public anger over the cost of prescription drugs.
Tennessee is one of several states moving aggressively to regulate these companies. Along with Arkansas, Tennessee has passed or is considering legislation designed to curb PBM practices. These state-level efforts reflect growing impatience with federal inaction and a recognition that the rising cost of healthcare remains one of the most pressing concerns for voters of all political persuasions.
The Josephs' frustration is not merely ideological. It is grounded in the practical realities of managing a chronic health condition in a system that often seems designed to extract maximum revenue. Amye Joseph notes that the lack of transparency in drug pricing makes it impossible to know why a medication costs what it does or why the price changes from month to month. The couple's experience mirrors that of millions of Americans who rely on prescription drugs and feel powerless against a system they do not understand and cannot control.
Healthcare experts point out that the PBM business model is inherently opaque. These companies negotiate rebates and discounts from drug manufacturers, but how much of those savings are passed on to patients and employers is often unclear. Critics contend that PBMs sometimes steer patients toward more expensive drugs to capture higher rebates, or use their market power to disadvantage independent pharmacies.
The political implications are significant. As the 2026 midterm elections approach, candidates in both parties are searching for issues that resonate across the ideological divide. Healthcare costs consistently rank among voters' top concerns, and attacking PBMs allows politicians to position themselves as champions of ordinary Americans against corporate greed. This dynamic explains why Tennessee and Arkansas, states with very different political cultures, are both moving forward with regulatory efforts.
For the Josephs, the issue is personal. They say the current system forces them to make decisions based on cost rather than medical need—a reality that feels fundamentally un-American. Their shared disdain for CVS Health has become a bonding agent in their marriage, a rare point of agreement in a polarized era.
"They're not even a middleman," Amye Joseph said. "They're a money grab." That sentiment, once a fringe view, has now entered the mainstream of American political discourse. As states take action and federal lawmakers take notice, the pharmaceutical middlemen may be facing their most serious regulatory challenge yet.
What remains to be seen is whether this bipartisan frustration will translate into meaningful reform. The healthcare industry is powerful, well-funded, and adept at influencing legislation. But the intensity of public anger, combined with the unusual alignment of Democrats and Republicans, suggests that pharmacy benefit managers will be under increasing pressure to justify their role in the prescription drug supply chain. For families like the Josephs, that pressure cannot come soon enough.
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