Like millions of others in the military community, I receive my prescription medications through the TRICARE Pharmacy Program. This program is administered by Express Scripts — the second largest pharmacy benefit manager (PBM) in the United States — covering 90-100 million Americans, including 9.5 million TRICARE beneficiaries.

Shortly after I retired from the Navy in 2009, like most Americans, I remember hearing that if I liked my doctor, I could keep my doctor. I assumed I could keep my pharmacy too. It turns out, however, that in Arkansas, in Tennessee where I retired, and possibly other states like Louisiana, that might not be the case.

Arkansas Act 624, which targets “pharmacy middlemen,” was signed into law by Gov. Sarah Huckabee Sanders in April 2025, prohibiting PBMs or their affiliates from owning or operating pharmacies there. This new law negatively impacts Express Scripts and CVS Caremark, a major PBM with 23 retail pharmacies throughout the state that CVS has now vowed to shutter.

In the lawsuit seeking to overturn the new law, Express Scripts argues that “millions of Americans nationwide and hundreds of thousands of Arkansans rely on PBM-affiliated pharmacies for their prescription medications.” It notes they “served for more than 20 years as the principal mail-order pharmacy provider for the U.S. Department of Defense’s TRICARE program, which provides healthcare services to military members, retirees, and families.”

Unfortunately, there’s now a move in Tennessee to follow the Arkansas bad example and significantly restrict PBMs. State Sen. Bobby Harshbarger, R-Kingsport, is introducing state legislation that would exert more government control to purportedly save costs.

While consumers naturally would like to see lower prescription drug prices, it’s dubious that their prices would actually decrease since PBMs argue they do that already by negotiating rebates and scoring discounts from drug manufacturers at scale.

Moreover, as Tennessee is arguably even more remote than Arkansas, particularly considering the Blue Ridge Mountains, restricting pharmacy by mail will have a terrible impact on military retirees who often live in less expensive, rural areas to survive on pensions.

Express Scripts — and thus military beneficiaries — appear to be casualties in a political battle in Arkansas that now appears to be spilling east over the Mississippi. In their own lawsuit, CVS Health claims, “Act 624 is designed to target CVS Health, not to protect patients. Arkansas lawmakers crafted the law to exclude CVS Health’s pharmacy operations while protecting in-state pharmacy businesses, which often charge higher prices.”

Apparently the original version of the Arkansas bill would have also hurt Bentonville-based Walmart, which was seen as “a dealbreaker” by many lawmakers. Thus they carved out an exemption for Walmart while a top competitor, CVS, ends up leaving the state. Genoa, a subsidiary of UnitedHealth, has said it too is likely to close its 11 pharmacies in Arkansas.

While that’s a great deal for Walmart, it’s not so good for everyone else.

Whether or not PBM reforms are necessary appears to be an exceedingly complex issue across the country that one hopes isn’t being made for the wrong reasons.

Curiously, California Gov. Gavin Newsom recently rejected PBM reforms, vetoing SB 966 over cost and disruption fears, showing even progressive states are hesitant to overhaul PBMs.

Beyond elected officials, critics of PBMs are fairly active on the podcast circuit and news broadcasts. They cite cherry-picked anecdotes of cost differences in some individual cases to rile up audiences about a little-understood topic that impacts basically everyone who needs prescription drugs. Yet these folks typically use half-a-story, and leave out the positive aspects of PBMs — like a robust pharmacy-by-mail service, and more choices on where and how to buy medicines.

Arkansas’ Act 624, which will hamper TRICARE beneficiaries’ pharmacy access when it goes into effect in January, sets a dangerous precedent that will hurt military retirees and their families.

Tennessee shouldn’t follow suit, nor should other states. After military retirees served for at least 20 years on active duty, plus with wars in Iraq and Afghanistan and tens of thousands still suffering from wounds, the last thing we need is to have access to life-saving prescription drugs severely curtailed by state laws. We must do better.

Scott Gureck is a retired Navy captain and former executive vice president at the U.S. Naval Institute in Annapolis, Md. Military assignments include spokesman for the U.S. Pacific Fleet in Pearl Harbor, Hawaii, U.S. 7th Fleet in Japan and USS Independence during the China-Taiwan crisis of 1996. The opinions expressed here are his own.