- Mississippi can protect independent pharmacies without gambling with pharmacy access. Fix reimbursement. Require prompt payment. Prohibit abusive steering. Demand transparency. Enforce competition. Then let pharmacies compete for business.
A 2024 count identified 653 retail pharmacies serving nearly three million Mississippians. Meanwhile, one national analysis estimates that 244,045 Mississippi households already live in pharmacy deserts. And since 2021, 54 independent pharmacies have closed across our state.
If lawmakers return to Jackson next year with legislation forcing companies that manage prescription-drug benefits to divest the pharmacies they own, the proposal will be easy to sell.
Put the middlemen in their place. Break up the big companies. Protect the hometown pharmacist.
I understand the appeal. Independent pharmacists have legitimate complaints about reimbursement, audits, payment delays and business practices by pharmacy benefit managers, or PBMs. Those problems deserve attention.
But conservatives should be especially careful when the proposed solution is government deciding who may own a lawful business.
Arkansas tried it first.
In April 2025, Arkansas enacted Act 624, prohibiting PBMs from owning pharmacies in the state. Before the law could take effect, a federal judge issued a preliminary injunction, finding that the challengers were likely to succeed on claims that the law violated the Commerce Clause and was preempted as applied to TRICARE. Arkansas appealed, and the litigation continues.
The result so far is not a cheaper prescription or a newly opened rural pharmacy. It is a major constitutional fight over whether state government can dictate the ownership structure of an industry.
Tennessee followed this year with its own FAIR Rx Act. Gov. Bill Lee signed it in May, and CVS sued the state the same day. Express Scripts and the Pharmaceutical Care Management Association later filed their own challenges.
More important than the lawsuits is what Tennessee’s own fiscal analysts said.
They could not determine whether the legislation would save taxpayers money.
The Tennessee General Assembly’s fiscal memorandum says the law may increase expenditures for TennCare and the State Group Insurance Program because of higher drug-acquisition costs, dispensing fees and administrative expenses associated with rebuilding pharmacy networks. The analysts also acknowledged that savings might result from reducing anti-competitive practices. Their conclusion was straightforward: the net fiscal effect could not reasonably be determined.
That is hardly a compelling case for Mississippi to gamble with pharmacy access.
Our state is particularly vulnerable. Roughly 593,000 Mississippians were enrolled in Medicaid or CHIP this spring. More than half of Mississippi’s population is classified as rural. And an estimated 244,045 households already live in areas considered pharmacy deserts.
Closing or disrupting even a relatively small number of pharmacies can therefore matter more here than it might in a densely populated state.
And patients do not always simply drive farther when their pharmacy closes.
A national study published in JAMA Network Open found that among older adults affected by a pharmacy closure, adherence to statins dropped 5.9 percentage points almost immediately and remained lower during the following year. Similar declines occurred for beta blockers and oral anticoagulants.
That should matter greatly in Mississippi, which ranks 48th overall in America’s Health Rankings.
None of this means independent pharmacists are crying wolf.
They aren’t.
According to the Mississippi Independent Pharmacies Association, 54 independent pharmacies have closed in Mississippi since 2021. Pharmacists have repeatedly raised concerns about being reimbursed below their acquisition costs, unequal treatment between affiliated and unaffiliated pharmacies, audits and other PBM practices.
Those are legitimate problems, and Mississippi should address them directly.
The Legislature considered exactly that kind of approach this year. House Bill 1665 included reimbursement protections, restrictions on spread pricing and steering, greater transparency, additional oversight and other PBM reforms.
That is where conservatives ought to start.
If a PBM reimburses an independent pharmacy unfairly, regulate the reimbursement practice.
If it steers patients improperly, prohibit the steering.
If it hides rebates or spreads from the businesses and taxpayers paying the bill, require transparency.
If it delays legitimate payments, enforce prompt payment.
If it abuses market power, enforce competition laws.
But regulating misconduct is very different from government ordering private companies to dismantle their businesses.
That distinction matters.
Ownership-ban proposals have failed to advance in states including Indiana, New Jersey and Texas. Louisiana considered a similar proposal and did not enact it. Bills elsewhere have stalled. Arkansas enacted one and immediately found itself enjoined in federal court. Tennessee enacted another and now faces multiple federal lawsuits before the principal ownership restrictions take effect.
Perhaps those courts will ultimately uphold some or all of these laws. Perhaps companies will divest rather than close pharmacies. Perhaps independent pharmacies will replace every location affected.
But “perhaps” is doing a great deal of work.
Government should have a compelling reason, backed by evidence, before it tells a company that it must sell a lawful business. And lawmakers should be particularly cautious when the people bearing the risk are patients who may lose access to a pharmacy.
There is another reason conservatives should resist the temptation.
Vertical integration is not automatically good. It can create conflicts of interest, distort incentives and give large companies opportunities to favor their own affiliates. Regulators should police those abuses aggressively.
But vertical integration is not automatically bad either. It can create efficiencies, lower transaction costs and provide services that smaller competitors cannot economically provide.
A free market does not mean allowing large corporations to mistreat smaller competitors.
It also does not mean government gets to pick the competitors.
Mississippi can protect independent pharmacies without gambling with pharmacy access.
Fix reimbursement. Require prompt payment. Prohibit abusive steering. Demand transparency. Enforce competition.
Then let pharmacies compete for our business.
That is a better solution than having government decide who is allowed to own one.
