Arkansas is no longer just the place that gave us legends like Johnny Cash and Al Green—it’s now also the state that passed a first-if-its-kind law banning vertical integration between pharmacy benefit managers (PBMs) and pharmacies.
Arkansas Governor Sarah Huckabee Sanders on April 16 signed a law prohibiting any company that owns a PBM from also owning or operating pharmacies in the state. The goal of the law is to eliminate “conflicts of interest” that lead to higher drug prices and care delays, according to a press release.
“For far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications. Not anymore,” she said in the release.
Some see the law—which takes effect Jan. 1, 2026—as an important step forward to combat the negative consequences of vertical integration, such as high drug prices, in the pharmaceutical industry. Others see it as a threat to patient pharmacy access, as the law could lead to a wave of pharmacies in Arkansas permanently shutting their doors.
The PBMs’ side
CVS Health—which owns both a chain of roughly 9,000 retail pharmacies as well as Caremark, one of the Big 3 PBMs in the US—has said it would be forced to shut all its 23 pharmacies in Arkansas.
“The Arkansas Legislature and governor are choosing to close 23 community pharmacies, including some of the very few that are open 24 hours,” CVS spokesperson Amy Thibault said in a statement shared with Healthcare Brew. The company also claims the law would leave more than 500 CVS employees without a job, limit access to specialty care for 10,000 patients in the state, and raise annual health benefits costs by millions of dollars, according to the statement.
Patrick Conway, CEO of Optum Rx, UnitedHealth Group’s PBM, said during the company’s Q1 2025 earnings call on April 17 the law “concerns” the company significantly. UnitedHealth Group also owns Genoa Healthcare, a pharmacy chain with 11 pharmacies in Arkansas that specialize in mental health treatments.
“This could cut off access for those patients with things like schizophrenia, severe depression,” Conway said. “We’ll work with the state in the regulatory process post-legislation to try to address those populations and maintain access.”
Kelly Davis, a spokesperson for Optum Rx, said in a statement sent to us that proposals requiring PBMs and pharmacies to split “will have significant, unintended negative consequences on patients with conditions like HIV, bipolar disorder, cancer, neurological disorders, and others.”
“Patients, including those covered by Medicare and Medicaid, will lose access to the high-quality specialized care from the specially trained pharmacists who they rely on through Optum pharmacies,” Davis said.
Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a trade group that represents PBMs, said in a statement to us that the law is “extremely dangerous for patients in Arkansas.”
“People will lose home delivery prescription drug programs, patients with complex medical conditions will have less access to specialty pharmacies, and retail pharmacies in Arkansas will be forced to close,” he said.
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Express Scripts, the third major PBM that also operates a mail-order specialty pharmacy called Accredo, did not respond to Healthcare Brew’s request for comment by publication.
The pharmacists’ side
The National Community Pharmacists Association (NCPA), which represents independent pharmacies across the US, said in a statement on April 29 the law will “help put an end to anticompetitive tactics like patient steering, below-cost reimbursements, and punitive audit practices, all while promoting Arkansans’ access to quality pharmacy care.”
A report released by the Federal Trade Commission in July 2024 found PBMs have “significant influence” over which drugs patients can access and what they cost. A second report in January found the Big 3 PBMs marked up some drug prices by “thousands of percent.”
The Arkansas Pharmacists Association, a professional group for pharmacists in the state, also supports the law, with CEO John Vinson saying in a statement “ending PBM ownership of pharmacies is essential” to lower drug costs, support local businesses, and protect patient choice.
Unclear consequences
Some experts fear the new law will create pharmacy deserts, or areas where residents must travel far to reach the nearest drugstore.
“I think it’s better to find other ways to regulate PBMs in a way that doesn’t shut down pharmacies,” Omolola Adepoju, a health services researcher and clinical associate professor at the University of Houston’s college of medicine, told Healthcare Brew. “If you reside in a rural community and there’s…just one CVS, the question is, how much farther do you have to travel to reach another pharmacy?”
Though proponents of the law argue it could help drive down drug costs because PBMs wouldn’t be able to give better reimbursement rates to their own pharmacies, Adepoju said it could also do the opposite. Smaller independent pharmacies that aren’t owned by a PBM don’t have the volume or bargaining power larger chains like CVS have to negotiate drug prices with manufacturers and insurers, she said.
But Dima Qato, associate professor of clinical pharmacy and spatial sciences at the University of Southern California, told Healthcare Brew that while some pharmacies may close in the short term, the law could spur more independent pharmacies to open and fill the gaps.
Since the Arkansas bill was introduced in January, legislators in Indiana, New York, Texas, and Vermont have introduced similar bills, according to the NCPA.
It would be better for Arkansas residents if the law were implemented slowly so many pharmacies don’t close all at once, Qato said.
“I think, in the long term, [the law] may improve equitable access to pharmacies in the state, but we really need to ensure that during this time…people have access to pharmacies and medications and other services they’re used to getting at those pharmacies,” she added. “So what is the state doing to ensure that?”