NASHVILLE, Tenn. (WCYB) — PBMs or Pharmacy Benefits Managers have become the topic of several pieces of legislation throughout the country. Most recently, Tennessee Senator Bobby Harshbarger filed SB2040 which, if passed, would prohibit PBMs from owning or operating retail or mail-order pharmacies, banning them from holding pharmacy licenses in the state.
Harshbarger, a pharmacist himself, says these PBMs are the cause of several issues within the states’ pharmaceutical landscape.
What are PBMs?
PBMs are essentially middlemen between insurance companies, drug manufacturers, and pharmacies to manage prescription drug benefits for employers and insurers.
They negotiate drug prices, and process claims, aiming to lower costs, but in recent memory, they have often been criticized for contributing to high drug prices and low reimbursements for independent pharmacists.
According to the latest data, the four largest PBMs in the country own about 67% of the market, while also utilizing vertical integration.
CVS Caremark, for example, is a PBM. Caremark is owned by CVS Health, which also owns Aetna, an insurance company.
Harshbarger says, this type of vertical integration has allowed these large corporations to benefit their own subsidiaries, harming independent pharmacies; something he wants to limit in the state.
“A good analogy is when you’ve got two ball teams playing one another and the referee happens to own the other team. Tell me how that works,” he said.
CVS Pharmacy
This week, representatives with CVS Pharmacy were in Nashville, advocating against this bill.
Representatives with CVS call this a “pharmacy closure bill.”
They say, if the bill is passed, they will be forced to close their 134 pharmacies in Tennessee, and more.
“If you look at CVS specifically, we also have 25 Minute Clinics in Tennessee. Those are retail medical clinics that are inside our stores. Those would also have to close. We can’t have a store with no pharmacy and no front store and just a clinic inside,” Amy Thibault, CVS Health corporate communications executive director, said.
Harshbarger, a pharmacist himself says, if CVS and other PBM-affiliated pharmacies were to close following the passage of this bill, it would be a business decision, not because of the language within the legislation.
“This bill in itself, when you read the language, it does not force any closures of any kind,” he said. “You hear misinformation from the PBM industry, they are automatically saying that everything is going to be closed. That’s exactly what they said in Arkansas when a similar bill was passed and to me that’s fearmongering.”
CVS, who owns a much smaller set of stores in Arkansas than in Tennessee, are still operating in the state as ‘Arkansas Act 624,’ a similar piece of legislation to SB2040, is currently held up in court after a federal judge granted a preliminary injunction in July of 2025.
Harshbarger doubled down saying, the bill would not restrict PBMs from operating in the state but it would force CVS and other PBM-affiliated pharmacies to disassociate with their parent company owned PBM.
“Divestment does not equal closure,” he said. “I have full confidence in the ecosystem in Tennessee to view absorb and to be able to take those transfer patients if worst case scenario the businesses decision is made that [would] close pharmacies.”