Dr. Micah Lansford, Pharmacist and Owner, Roden-Smith Pharmacy, testifies during a Senate Armed Services Subcommittee on Personnel hearing on July 15, 2026, in Washington to provide testimony on the Tricare pharmacy program. (Eric Kayne/Stars and Stripes)
ABOUT THE AUTHOR: Patrick McSpadden is a retired U.S. Air Force lieutenant colonel and former intelligence officer with more than 21 years of service, including multiple operational deployments. He writes on defense policy, military technology and national security. The views expressed are his own and do not reflect the official position of the Department of Defense or the U.S. government.
For more than two decades in the Air Force, I rarely thought about the mechanics behind getting a prescription filled. Like most service members, I cared about whether my family and I could get the medication we needed, when we needed it.
Now, as a military retiree using Tricare, I look at the health care system from a different perspective. That is why the growing debate over pharmacy benefit managers, or PBMs, deserves attention from the military and veteran community. PBMs sit between health plans, drug manufacturers and pharmacies, negotiating prices and managing prescription drug benefits.
Over time, the industry has become increasingly vertically integrated, with some of the same companies operating health plans, PBMs and pharmacies. This model allows for an effective supply chain of care and savings for patients. Big systems often need correcting and reform, but that reform should also be judged by what happens to patients after the policy takes effect.
In health care, especially for military families and retirees, access matters as much as market structure. Tennessee offers an important test case.
In May, Gov. Bill Lee signed SB 2040, the Freedom, Access, and Integrity in Registered Pharmacy Act, or FAIR Rx Act. The law restricts companies from simultaneously controlling a pharmacy, a health insurance issuer and a PBM. Its principal ownership restrictions are scheduled to take effect July 1, 2028. The goal is to address concerns about vertical integration and competition in the pharmacy market.
But Tennessee’s own fiscal analysis makes clear that implementing such a significant restructuring of the pharmacy market could bring many downstream effects. While the analysis suggests possible savings from reducing certain noncompetitive business practices, it also identifies potential costs. The law could increase drug acquisition expenses, professional dispensing fees and administrative costs as pharmacies and health plans modify or renegotiate pharmacy networks and reimbursement arrangements.
This leaves which pharmacies and networks will remain operational hanging in the balance. That uncertainty matters beyond Tennessee’s state budget. For military families and retirees, pharmacies are not simply another part of the health care marketplace. They are where the Tricare benefit becomes real. People managing chronic conditions, recovering from surgery or caring for children do not experience pharmacy policy as an abstract debate over corporate structure. They experience it at the counter when they try to fill a prescription they need to keep living.
Other states should take this as a warning. When legislative focus shifts from quality health care to regulatory structures, patients — and veterans especially — lose. If the implementation of a bill causes pharmacies to close, change ownership or alter their participation in pharmacy networks, patients may have to find another place to fill their prescriptions. That isn’t effective governance, it is private interests taking over.
In a rural community, or a town where only a handful of pharmacies participate in a patient’s network, the consequences can be more significant. That concern is particularly relevant for Tricare beneficiaries. Military retirees and families live in communities across the country, often far from military treatment facilities. Many depend on civilian pharmacies participating in the Tricare network.
When a pharmacy leaves a network or closes, the practical question is not who owned it. The question is where the patient goes next. The Department of Veterans Affairs can take months to register a new designated pharmacy.
And none of this means policymakers should ignore the need for reform. Competition matters. Transparency matters. But reform can be good policy without creating problems for patients. The challenge is avoiding a cure that creates a different problem.
Policymakers in other states should closely watch what happens to pharmacy participation, prescription costs and geographic access, particularly in rural communities, across Tennessee, and guard against similar mistakes. They should also pay attention to how changes in the broader pharmacy market affect people whose prescription coverage comes through federal programs such as Tricare.
For those of us who spent our careers in uniform, reliable health care is part of the promise made in exchange for service. Most veterans will never study the corporate structure of a PBM, nor should they have to. They care whether the prescription their doctor writes can be filled at a pharmacy they can reasonably reach. The debate over PBMs will continue, and reform will continue with it.
Tennessee has already chosen its approach. Other states don’t have to make the same mistakes. Think of what will happen at the pharmacy counter, if they can even find one to fill their prescriptions. For military families and retirees, that is where the consequences will matter most.
