Millions of Americans already struggle to reach a pharmacy. Now lawmakers pursuing lower prescription drug prices are backing ownership restrictions that could force patients to travel farther or, even worse, leave them without a nearby pharmacy altogether.
A new Goldwater Institute report, Don’t Force Patients into the Pharmacy Desert: Pharmacy Benefit Manager Ownership Bans Endanger Patient Access, authored by Goldwater Institute Senior Fellow Naomi Lopez, warns that sweeping prohibitions on pharmacy ownership could disrupt care in communities with the fewest alternatives. The report urges lawmakers to address abusive business practices without making it harder for patients to obtain their medications.
The stakes are substantial. A 2025 study published in JAMA Network Open, cited in the report, found that 57.1 million Americans live in pharmacy deserts—communities with low incomes and limited pharmacy access. Another 28.9 million depend on a single pharmacy whose loss could leave them with similarly limited access. For these patients, a local drugstore provides more than prescription refills. It is a place to receive vaccinations, ask questions about medications, and get help managing prescriptions.
Pharmacy benefit managers, or PBMs, negotiate drug discounts, process claims, and administer prescription benefits for employers, insurers, and public programs. Their purchasing power can help control costs. But some belong to companies that also own insurers and pharmacies, raising legitimate concerns about whether they steer patients toward affiliated businesses or disadvantage independent competitors.
Lawmakers should examine those practices. Forcing companies to shutter or sell their pharmacies, however, could disrupt patient care without addressing the underlying misconduct. “Ownership bans focus on corporate structure rather than whether particular conduct harms—or benefits—patients,” the report explains.
The federal Patients Before Monopolies Act would prohibit common ownership of pharmacies and PBMs or insurers, requiring divestiture within one year. That deadline could force rapid changes to pharmacy networks without ensuring that other providers could serve patients whose pharmacies close or leave those networks.
State efforts illustrate the risks. Arkansas’s ownership ban was temporarily blocked by a federal judge before taking effect. In Tennessee, CVS has warned that the state’s ban could require it to close 136 pharmacies. Those closures are not certain, but Tennessee’s own fiscal analysis acknowledged the possibility of pharmacy closures and operational disruptions, with rural communities particularly vulnerable.
Patients and taxpayers deserve more than promises that restructuring the industry will lower costs and preserve access. Goldwater’s report recommends stronger transparency and audit rights, limits on spread pricing, protections against patient steering, and access to cheaper cash prices when insurance copays cost more. It also calls for prompt access to lower-cost generics and biosimilars and updated telepharmacy rules to help underserved communities.
Before imposing ownership restrictions, lawmakers should assess which pharmacies would be affected, how far patients would have to travel, and whether remaining providers could meet their needs.
“Health care reform should make care more available, not harder to reach,” the report concludes. “For millions of Americans, the pharmacy desert is already real. Lawmakers should not make it larger.”
Read Don’t Force Patients into the Pharmacy Desert: Pharmacy Benefit Manager Ownership Bans Endanger Patient Access here.
