Imagine a healthcare system where the referees are also playing the game. That's essentially what's happening with Pharmacy Benefit Managers (PBMs), and it's causing quite a stir in Tennessee. But here's where it gets controversial... Tennessee Senator Bobby Harshbarger has proposed a bill, SB2040, that would ban PBMs from owning or operating pharmacies in the state, a move that has CVS threatening to shut down its 134 pharmacies and 25 Minute Clinics if the bill passes. This bold legislation aims to address what Harshbarger, a pharmacist himself, sees as a major conflict of interest in the pharmaceutical industry.
So, what exactly are PBMs? Think of them as the middlemen between insurance companies, drug manufacturers, and pharmacies. Their job is to manage prescription drug benefits for employers and insurers by negotiating drug prices and processing claims. Sounds good in theory, right? And this is the part most people miss... While PBMs claim to lower costs, they've recently come under fire for allegedly driving up drug prices and reducing reimbursements for independent pharmacists. According to the American Medical Association, the four largest PBMs control a staggering 67% of the market, often through vertical integration—a strategy where a single company owns multiple stages of the supply chain.
Take CVS Caremark, for example. Caremark, a PBM, is owned by CVS Health, which also owns Aetna, an insurance company. Harshbarger argues that this vertical integration allows these corporate giants to favor their own subsidiaries at the expense of independent pharmacies. He uses a compelling analogy: “It’s like having two teams play against each other, but the referee owns one of the teams. How fair is that?”
This week, CVS representatives were in Nashville, lobbying against the bill, labeling it a ‘pharmacy closure bill.’ Amy Thibault, CVS Health’s corporate communications executive director, warned that closing pharmacies would also mean shutting down their in-store Minute Clinics, leaving patients with fewer healthcare options. But Harshbarger isn’t buying it. He insists that any closures would be a business decision, not a direct result of the bill’s language. “This bill doesn’t force closures,” he said. “The PBM industry is spreading misinformation, just like they did in Arkansas when a similar bill was passed. It’s fearmongering.”
Speaking of Arkansas, a similar law, ‘Arkansas Act 624,’ is currently tied up in court after a federal judge issued a preliminary injunction in July 2025. Despite the legal battle, CVS still operates in Arkansas, though on a smaller scale compared to Tennessee. Harshbarger clarifies that the bill wouldn’t prevent PBMs from operating in Tennessee; it would simply require CVS and other PBM-affiliated pharmacies to separate from their parent company’s PBM. “Divestment doesn’t mean closure,” he explained. “Tennessee’s healthcare ecosystem is robust enough to handle the transition if pharmacies decide to close.”
Here’s the million-dollar question: Is this bill a necessary step to level the playing field for independent pharmacies, or is it an overreach that could disrupt healthcare access for Tennesseans? What do you think? Let’s spark a conversation—do you agree with Harshbarger’s approach, or do you side with CVS? Share your thoughts in the comments below!
