American Pharmacists Month: PBM Reform, Provider Status Key in Stopping Pharmacy Deserts

Pharmacists say closing pharmacy deserts will require a dual approach toward policy change, including pharmacy benefit manager (PBM) reforms that help independent pharmacies stay open and expanded provider status that lets pharmacies offer more than just medication dispensing.

“I think the legislation is probably some of the most important changes, just outside of the actual opening of the pharmacies and some of the structural or logistical issues surrounding pharmacy deserts,” Kimberly Kue-Tsemo, PharmD, clinical pharmacist at George Washington Medical Faculty Associates, told Drug Topics®. “I understand that pharmacy deserts are an access issue, but I also think that if we have the pharmacy there, we can now also be providing some of the health care that these patients are needing because, if there’s a pharmacy desert, you can only imagine there’s likely a shortage of all health care professionals.”

Kue-Tsemo emphasizes that PBMs have become deeply integrated into the entire patient care journey, spanning insurance administration, pharmacy benefit oversight, and drug dispensing. This extensive integration, combined with PBMs operating their own retail pharmacies, creates severe competitive hurdles for independent community drugstores that lack equivalent leverage and resources.

READ MORE: American Pharmacists Month: Why Technology Cannot Replace Traditional Pharmacy

Across the US, more than 57 million individuals currently reside in pharmacy deserts, while another 28.9 million depend on a single keystone pharmacy where a closure would immediately eliminate local prescription access.¹

The financial pressure on community practice is further intensified by unpredictable reimbursement models, where pharmacies sometimes incur losses ranging between $80 and $100 per prescription when dispensing brand-name treatments for diabetes and weight-loss medications.²

Legislative Measures and Legal Battles Over PBM Regulation

To address these compounding market pressures, state legislatures have initiated aggressive statutory efforts to curb middleman practices and structural dominance. State lawmakers have introduced over 120 bills targeting PBMs, attempting to enforce transparency, mandate minimum reimbursement rates, or restrict middleman compensation.¹

Most notably, Arkansas passed legislation prohibiting PBMs from owning and operating retail pharmacies within the state, signaling a growing legislative willingness to confront vertical integration. However, state regulatory efforts face formidable judicial headwinds from industry lawsuits.³

In Flowers v. Caremark PCS Health, the 8th Circuit Court of Appeals determined that state-mandated geographic coverage requirements for pharmacy networks were preempted by federal ERISA law. Furthermore, federal district courts issued preliminary injunctions against PBM ownership restrictions in Arkansas and Tennessee, citing potential violations of the Commerce Clause as well as preemption by federal programs like TRICARE and Medicare Part D.

On the federal level, legislative momentum continues as lawmakers evaluate broader structural solutions.¹

Federal proposals such as the Patients Before Middlemen Act and the Patients Before Monopolies Act seek to increase middleman accountability, restructure Part D compensation models, and potentially decouple pharmacy ownership from benefit administration. Additionally, statutory provisions within the Consolidated Appropriations Act of 2026 will delink Part D compensation from drug prices and mandate complete rebate pass-through for employer health plans starting in 2028.

These statutory changes aim to relieve extreme financial pressures on independent pharmacies, which remain 3.1 times more likely to close if excluded from Part D preferred networks.²

Expanding Pharmacist Provider Status and Community Care Capabilities

Beyond financial and PBM reforms, expanding scope of practice and securing formal provider status represent the second essential pillar in eliminating pharmacy deserts. Pharmacists are extensively trained clinical professionals who offer crucial health care services well beyond medication dispensing, including chronic disease state management, medication therapy management, and routine immunizations.

During the 2023-2024 respiratory virus season alone, community pharmacies administered 36.6 million influenza vaccine doses, highlighting their expanding role as frontline primary care providers. States such as New Mexico have led the way by expanding clinical scopes of practice, establishing models for how community drugstores can deliver accessible care in underserved regions where primary care physicians are scarce.²

To cement these clinical advances permanently, federal legislation known as the Main Street Pharmacy Access Act seeks to amend the Social Security Act to recognize pharmacists as covered providers under Medicare Part B. Formerly recognized as the Ensuring Community Access to Pharmacists Act, the bill codifies pandemic flexibilities that allow pharmacists to test, treat, and vaccinate for upper respiratory illnesses such as influenza, COVID-19, and respiratory syncytial virus.⁴

According to Chad Worz, PharmD, BCGP, FASCP, CEO of the American Society of Consultant Pharmacists, establishing dedicated Medicare Part B billing codes independent of product dispensing creates a sustainable financial foundation for ongoing clinical evaluation and disease management. Supported by over 190 health care organizations, this legislation ensures that local pharmacies can deliver convenient primary care services, helping preserve essential health care access for rural and medically underserved populations across the nation.

READ MORE: American Pharmacists Month Resource Center

REFERENCES

1. Lopez N. Don’t force patients into the pharmacy desert: pharmacy benefit manager ownership bans endanger patient access. The Goldwater Institute. September 24, 2026. Accessed October 29, 2026. https://www.goldwaterinstitute.org/policy-report/dont-force-patients-into-the-pharmacy-desert/

2. Berenbrok LA, Carpenter D, Salgado TM, et al. Building on the 2025 National Academies Pharmacy Workshop: pharmacy deserts in the United States. Health Aff Sch. 2026;4(10):qxag256. doi:10.1093/haschl/qxag256

3. Alexander RA, Carnegie TC, Hupart JH, et al. State regulation of PBMs subject to robust legal challenges. Mintz. July 8, 2026. Accessed October 29, 2026. https://www.mintz.com/insights-center/viewpoints/2146/2026-07-07-state-regulation-pbms-subject-robust-legal-challenges

4. Nowosielski B, Worz C. The legislation setting the stage for pharmacy’s next leap. Drug Topics. September 24, 2026. Accessed October 29, 2026. https://www.drugtopics.com/view/the-legislation-setting-the-stage-for-pharmacys-next-leap