(InvestigateTV) — Pharmacies across the United States are closing at an accelerating rate, and independent operators say a powerful set of industry middlemen is largely to blame.
Between 2010 and 2021, about one in three pharmacies closed, according to a study led by researchers at the University of Southern California. Independent pharmacies were more than twice as likely to face closure as chain pharmacies.
As pharmacies continue to shutter, the healthcare company GoodRx reports that millions of Americans now live in areas where filling a prescription requires a lengthy drive and possibly longer wait times.
What are pharmacy benefit managers?
Researchers say one of the key factors putting independent pharmacies at risk is pharmacy benefit managers, or PBMs.
Established in the late 1950s, PBMs act as the middleman in the prescription drug supply chain, negotiating prices with drug manufacturers and pharmacies. They also decide which medications are covered by a health plan.
“Whatever drug companies pay the PBM the most rebate money, they get to be on that list,” said Minh Nguyen, an independent pharmacist. “So if your doctor prescribes you a certain drug and if it’s not on that preferred list, it’ll probably be impossible for you to get the drug you want.”
Critics of PBMs say they limit patient access to care and are responsible for driving up drug costs, as medications on their preferred list are often more expensive brand-name drugs.
A pharmacist’s daily fight
Dave Randolph opened Dave’s Pharmacy more than a decade ago with two locations and no chain pharmacies for miles.
“I always have had a heart for local community care where you dealt with a patient face to face,” Randolph said. “You see them when they’re babies and then you see them when they graduate. I love that aspect and it’s worth fighting for.”
But Randolph says the fight is getting harder.
“Every day we fill prescriptions at a loss to take care of people,” he said. “And I appeal to the PBMs, ‘Hey, you didn’t pay me on this drug.’ And in 11 years, one of the PBMs, I’ve had no reversals to say, ‘We’ll give you more money.’”
Randolph says PBMs serve a purpose, but that the industry is rife with conflicts of interest.
“They have become so vertically integrated that they are either owned by an insurance company or own the insurance company,” he said. “They steer patients to their own pharmacies.”
Randolph says six to 10 pharmacies are closing every day in the U.S., including chains like CVS, which also owns one of the largest PBMs.
CVS Health defends PBMs
Prem Shah, executive vice president of CVS Health, rejects criticism over PBM transparency, pharmacy favoritism, and drug selection based on high rebates.
“Pharmacy benefit managers are a critical component of the health care system,” Shah said. “They make drugs more affordable in the United States. They also are the only ones in the supply chain that stand up to Big Pharma.”
Shah says CVS Health passes through more than 99% of rebates to its clients, who use those savings to reduce co-pays for patients. He also says the reimbursement model varies by drug type.
“They may have lower reimbursement for brand products that may put them slightly under water, and they make more money on generic products,” Shah said. “We pay independent pharmacies more than we pay ourselves for dispensing brand and generic drugs in this space.”
States and Congress push back
All 50 states have laws that regulate PBMs, but in recent years, some have taken further steps.
As of 2026, Arkansas has banned PBMs from owning retail pharmacies in the state. Louisiana enacted a law prohibiting “patient steering,” a practice in which PBMs funnel customers to specific pharmacies.
“I see this as a lifeline to the independent pharmacies, because it can’t continue the way it is,” one independent pharmacist said.
On the federal level, an April 2025 executive order from the Trump administration called for a reevaluation of PBMs’ role in the healthcare system. In December 2025, House lawmakers reintroduced the “Pharmacists Fight Back Act,” which aims to address pharmacy reimbursement and provide significant penalties for PBM violations.
For Randolph, the fight is personal — and ongoing.
“Because somebody has to,” he said when asked why he keeps going. “It’s worth fighting for. Our patients still choose to come to us. And I’m going to fight for that.”
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