Arkansas' pharmacy benefit manager ownership ban has a national impact

If PBM-owned pharmacies close, members could face sudden gaps in access to critical medications unless alternative partnerships are proactively secured.

While individual payers may not be in a position to directly impact these looming legislative changes, staying informed and making contingency plans can help mitigate unplanned costs and the potential negative impact on patient access.

Arkansas's legislation

The first-of-its-kind law enacted in Arkansas in April 2025 (HB 1150; Act 624) prohibits pharmacy benefit managers from owning or operating pharmacies within the state.

Arkansas may have been the first state to enact a PBM ownership ban, but it's far from alone.

Additional states, including Indiana, Vermont, Texas and more, are actively considering similar legislation that would restrict PBM-owned pharmacies, bolster independent pharmacies and combat what they perceive as anticompetitive operations.

Support for these efforts is also growing among pharmacy advocates.

The National Community Pharmacists Association called Arkansas's HB 1150 a meaningful step toward eliminating patient steering and anticompetitive practices that limit access to local pharmacies.

At the federal level, momentum is also building. A bipartisan coalition of 39 state and territory attorneys general has formally urged Congress to pass a nationwide ban on PBMs owning or operating pharmacies.

But the PBM industry is fighting back. Two of the three largest PBMs — CVS Health and Express Scripts, the PBM unit of Cigna — have already filed lawsuits challenging the new Arkansas law.

Both companies argue that HB 1150 is unconstitutional and are seeking to block its implementation in federal court. (Just as this article went to press, a federal judge issued a preliminary injunction blocking implementation of the law.)

The lawsuits name Arkansas's State Board of Pharmacy as defendants and have drawn strong reactions from state leaders who publicly criticized the legal challenge and defended the law as a measure to protect patient access and affordability.

Pharmacy deserts

The consequences of HB 1150 are already taking shape, raising urgent concerns about access to care.

If PBM-owned pharmacies are forced to close, many members could face sudden disruptions in receiving essential medications, especially those delivered by mail or dispensed through specialty networks.

Large pharmacy chains are already making adjustments. CVS has announced it will shutter 23 retail pharmacies in Arkansas in response to the new restrictions. Others have issued public statements cautioning potential disruptions to hundreds of thousands of prescriptions and criticized the Act's potential to limit patients' access to drugs, increase prescription drug spending in the state, cost jobs and hurt local revenues.

The situation could continue to escalate.

According to the Pharmaceutical Care Management Association, more than 35 pharmacies are at risk of closing and mail-order delivery programs could be suspended, posing serious challenges for patients who rely on convenient or rural access to their prescriptions.

Red flags

National plans are now navigating a fragmented landscape of inconsistent state laws.

This increases operational complexity and makes it harder to provide consistent pharmacy access across the country.

Disruption at the member level is a serious concern. Confusion or loss of access can lead patients to switch plans, which impacts retention, satisfaction scores and overall member trust.

Without tailored, state-specific strategies, plans may encounter service gaps, revenue loss and reputational risks.

The legal risks

Plan sponsors face growing pressure to maintain cost-effective, uninterrupted access to medications or risk potential legal action.

A recent case involving a major employer underscores the risks tied to inadequate oversight of pharmacy benefit arrangements.

Employers also have a fiduciary duty to ensure that PBM and pharmacy partners provide reliable access to medications, particularly for members managing chronic or rare diseases.

Impact on LDD access

Self-insured and regional plans often have more flexibility than large national payers. They can move faster, are not locked into monolithic PBM contracts and can adapt more easily to local needs.

These plans can contract directly for LDDs, work with independent specialty networks and customize support services to improve adherence and outcomes.

This agility helps reduce risk while boosting member satisfaction.

The stakes around LDD access are compelling.

LDDs are high-cost, complex therapies that manufacturers restrict to a select group of specialty pharmacies.

These medications often require special handling, monitoring or clinical oversight, making uninterrupted access critical for patients with conditions such as cancer, multiple sclerosis or rare genetic disorders.

Many LDDs are dispensed only through PBM-owned specialty pharmacies. If those pharmacies shut down due to laws like HB 1150, patients could suddenly lose access to life-sustaining treatments.

While HB 1150 includes a temporary "limited use permit" through 2027 for certain rare or unavailable drugs, this is only a short-term solution. Long-term strategies are essential to maintain access.

Filling the gaps

These networks can also provide transparent rebate management, support medical claims processing and monitor patient adherence — without violating new laws.

For rural and underserved regions that rely on mail delivery, these networks can continue to provide fulfillment where other options are no longer viable.

What to do now

Review PBM contracts: Many contain clauses that allow renegotiation or termination in response to regulatory changes.

Identify alternatives early: Pre-vet independent specialty pharmacy partners before pharmacy closures create service gaps.

Start member communication: Provide clear updates to minimize confusion and support adherence as changes take place.

Assess network coverage: Map out pharmacy access by geography, particularly in states where legislation is pending.

Choosing a partner

To minimize disruption and ensure compliance, plan sponsors should look for independent partners that:

◆ Are fully independent from PBMs and health insurers.

◆ Have access to LDDs and specialty medications through manufacturer agreements.

◆ Offer integrated capabilities for rebate handling, claims processing and adherence support.

◆ Can scale services across local, regional and national populations.

◆ Provide home delivery and serve rural communities effectively.

As more states move to restrict PBM-pharmacy ownership, the ability to pivot quickly and responsibly will separate the prepared from the vulnerable.

Health plans that take proactive steps now — identifying qualified, experienced partners and preparing members for change — will be best positioned to maintain continuity of care and meet growing expectations around transparency, access and cost control.

Clayton Edwards, RPh, MBA, is senior vice president, Payer Business Unit, at AscellaHealth, a specialty pharmaceutical services firm.