A new Goldwater Institute report warns that proposed restrictions on pharmacy ownership could leave tens of millions of Americans without nearby access to prescriptions, vaccines, and medication counseling. The report, titled *Don't Force Patients into the Pharmacy Desert: Pharmacy Benefit Manager Ownership Bans Endanger Patient Access* and authored by Senior Fellow Naomi Lopez, argues that lawmakers pursuing lower drug prices through ownership prohibitions risk disrupting care in communities with the fewest alternatives. Published in 2025, the analysis urges policymakers to tackle abusive business practices without making it harder for patients to obtain medications.
The scale of the problem is already substantial. According to a 2025 study in JAMA Network Open cited in the report, 57.1 million Americans live in pharmacy deserts—areas with low incomes and limited pharmacy access. Another 28.9 million people rely on a single pharmacy whose closure could leave them with similarly restricted access. State-level impacts could be severe: CVS has cautioned that Tennessee's ownership ban might force it to shutter 136 pharmacies, and Arkansas's similar restriction was temporarily blocked by a federal judge before implementation. The federal Patients Before Monopolies Act would ban common ownership of pharmacies and pharmacy benefit managers or insurers, requiring companies to divest within one year.
The report finds that "ownership bans focus on corporate structure rather than whether particular conduct harms—or benefits—patients." Tennessee's own fiscal analysis acknowledged the possibility of pharmacy closures and operational disruptions, with rural communities particularly vulnerable, according to the report. Lopez concludes that "health care reform should make care more available, not harder to reach," warning that "for millions of Americans, the pharmacy desert is already real. Lawmakers should not make it larger."
Pharmacy benefit managers negotiate drug discounts, process claims, and administer prescription benefits for employers, insurers, and public programs, and their purchasing power can help control costs. But some belong to companies that also own insurers and pharmacies, raising concerns about whether they steer patients toward affiliated businesses or disadvantage independent competitors. The report explains that forcing companies to shutter or sell their pharmacies could disrupt patient care without addressing the underlying misconduct. The one-year divestiture deadline in the federal legislation could force rapid changes to pharmacy networks without ensuring that other providers can serve patients whose pharmacies close or leave those networks.
Rather than imposing ownership restrictions, the report recommends stronger transparency and audit rights, limits on spread pricing, protections against patient steering, and access to cheaper cash prices when insurance copays cost more. It also calls for prompt access to lower-cost generics and biosimilars and updated telepharmacy rules to help underserved communities. Before enacting ownership bans, lawmakers should assess which pharmacies would be affected, how far patients would have to travel, and whether remaining providers could meet their needs. Patients and taxpayers deserve more than promises that restructuring the industry will lower costs and preserve access.