You can’t fight pharmacy deserts by putting pharmacies at risk

By JIM MERRITT
Guest Columnist

Indiana has a pharmacy access problem. The last thing it needs is to revive a proposal that could put existing pharmacies at risk.

Lawmakers considered pharmacy-ownership restrictions in 2025 but removed them before passing a broader pharmacy benefit manager reform law. Before returning to that approach, they should confront a problem. Some communities depend on the pharmacies an ownership ban would affect.

An Indiana Capital Chronicle article captured the contradiction. Darren Covington, executive vice president of the Indiana Pharmacy Association, called Arkansas’s ownership ban the “North Star” of reform. But the article also reported his acknowledgment that many areas of Indiana are served only by CVS.

That is the central issue.

If a community already depends on one pharmacy, putting its future in question raises an obvious question. Where are patients supposed to go?

The goal should be access, not an ownership purity test.

Indiana has no margin for error

Indiana’s licensed-pharmacy count fell further from November 2024 to July 2025. Even more concerning, a 2021 study cited in the article found that 60 percent of Indianapolis neighborhoods qualified as urban pharmacy deserts.

In central Indiana and across rural communities, Hoosiers are already feeling the effects of pharmacy closures. Some former pharmacies become other stores. Others sit vacant. Either way, patients lose a place to fill prescriptions. Indiana needs to stem these closures. Longer trips make health care harder to reach and add costs for families already feeling squeezed.

For patients with complex medical needs who lack resources, technology, or family support, finding another pharmacy is not necessarily a matter of driving a few extra minutes.

Yet the ownership-ban debate treats existing pharmacies as interchangeable pieces on a corporate chessboard.

Patients do not fill prescriptions at an organizational chart. They need a counter they can reach, a prescription they can obtain and service they can depend on.

The sign above the door does not change those needs.

Tennessee’s warning is in writing

Before Indiana revisits an ownership ban, lawmakers should read Tennessee’s fiscal analysis.

Tennessee enacted its FAIR Rx Act this year, with ownership restrictions scheduled to begin July 1, 2028. Reviewing an earlier version, the General Assembly’s Fiscal Review Committee acknowledged that “some pharmacy closures or operational disruptions may occur.”

Then came the warning Indiana should take personally.

“Any pharmacy closures that occur are likely to have the largest economic impact in rural areas of the state where fewer pharmacy providers operate.”

That is the assessment of the state’s legislative fiscal staff.

TennCare officials separately warned about consequences for treatment access and program finances.

The uncertainty is the point. “Someone else can buy it” is not a patient-access guarantee. Who is the buyer? Will the location stay open? What happens if no buyer materializes?

Lawmakers should answer those questions before voting, while patients still have a place to go.

Arkansas is a cautionary tale, not a blueprint

The Arkansas law praised as the “North Star” of reform in the Capital Chronicle article offers another reason for caution.

Arkansas enacted Act 624 in 2025 to prohibit PBMs from owning or operating pharmacies. Before its scheduled January 2026 implementation, a federal judge blocked enforcement, finding that the law likely violated the Constitution’s Commerce Clause and was likely preempted by TRICARE, the federal health program serving military personnel, retirees and their families.

The potential disruption was substantial. CVS warned that the law would force its 23 Arkansas stores to close, illustrating the existing access lawmakers were putting at risk.

Indiana should not confuse an ambitious restriction with a proven solution. Arkansas’s law encountered serious legal obstacles before taking effect. Banning an ownership structure does not magically put another pharmacy within reach.

Before following Arkansas or Tennessee, Indiana should demand a credible plan to keep patients connected to their prescriptions.

Target practices, not prescription counters

Concerns about reimbursement, transparency, and spread pricing deserve scrutiny. But identifying a problem does not make every proposed remedy sensible.

Before reviving an ownership ban, lawmakers should identify affected locations, map realistic alternatives, and explain how patients would maintain uninterrupted access.

Indiana has communities dependent on chain pharmacies. Tennessee’s analysts acknowledge that ownership restrictions could lead to closures. Anyone proposing that disruption should explain how it would improve access.

Patients should not have to wait for a corporate restructuring to learn whether they still have somewhere to fill a prescription.

You cannot fight a pharmacy desert by gambling with the pharmacy that is left.

Jim Merritt is a former State Senator who served Hoosiers in the General Assembly for more than three decades.