Dominguez: Texas pharmacies are closing at alarming rate. Lawmakers need to act.

An alarming number of pharmacies have closed in Texas in the past two years – a net closure of at least one pharmacy every week – threatening a critical access point to health care for many Texans.

Urban and rural communities alike are being affected by these pharmacy closures. From January 2023 through January 2025, Harris and Dallas counties topped the list with the most net pharmacy closures at 79 and 30, respectively. This was followed by Fort Bend County with 18, Hidalgo County with 15 and Tarrant County with nine net pharmacy closures.

These closures threaten access to pharmacies for growing numbers of Texans, especially in low-income urban and rural areas. In fact, 4.3 million Texans now live in a pharmacy desert. And nearly 2 million Texans rely on a single pharmacy whose closure would create a pharmacy desert, further undermining access to care.^[1]

Texas legislators can help blunt this trauma with new laws to rein in the anti-competitive, anti-consumer practices of middlemen in the pharmaceutical supply chain. These middlemen – known as pharmacy benefit managers (PBMs) – are not only forcing scores of neighborhood pharmacies out of business, but they are also driving up prescription drug costs for patients at the pharmacy counter.

PBMs, which manage the lists of prescription drugs covered by public and private health insurers, have been widely criticized for using a flawed system to profit unfairly at the expense of consumers, employee health plans and local pharmacies. While they may have started out with good intentions, PBMs have grown unchecked and now operate with little to no accountability. 

Today the nation’s three largest PBMs control the cost of the overwhelming majority of America’s filled prescriptions. They use this market power to direct patients to pharmacies they themselves own or control, and they throw up obstacles to competition for independent and chain pharmacies alike.

With this stranglehold on the pharmaceutical supply chain, PBMs decide which medicines patients can get and at what price. They dictate lower reimbursement rates for neighborhood pharmacies but then often pay their own pharmacies more. They also decide what employers must pay for a key piece of their employees’ health premiums.

A January 2025 Federal Trade Commission (FTC) report found that the three largest PBMs “marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent.” These included “critical drugs used to treat serious diseases and conditions, including cancer, HIV, multiple sclerosis, and pulmonary hypertension,” according to the report. “Additionally, the Big 3 PBMs reimbursed their affiliated pharmacies at a higher rate than unaffiliated pharmacies on nearly every specialty generic drug examined,” the report stated.^[2]

To address the anti-competitive tactics of PBMs, the Texas Pharmacy Association urges state lawmakers to ensure these middlemen operate in a transparent manner and provide fair compensation for pharmacy services. Specifically, we support a package of bills pending before the Legislature. They include:

• SB 1236 / HB 3317 – Protect patients and pharmacists from abusive PBM practices. Would require contract fairness and transparency, ensure compliance with existing PBM laws, and prohibit unfair fees.
• SB 1354 / HB 2978 – Prohibit below-cost reimbursement and require an appeal process for reimbursement errors.
• SB 1122 / HB 5102 – Ensure existing PBM reforms apply to all Texas residents and all PBMs in Texas.
• SB 493 – Ensure contracts between PBMs, health plans and pharmacies do not limit pharmacists’ ability to inform patients if their prescriptions would cost less when paying the cash price.
• HB 4533 – Require transparent reimbursement methodology for prescription drugs dispensed in Medicaid and state-funded programs.

For pharmacists, our priority is patient care, but PBMs’ abusive tactics threaten our ability to deliver quality health care to our communities. We’re not just small businesses; we’re critical health access points, often the first and sometimes the only health care touchpoint for many Texans.

We urge our lawmakers to hold PBMs accountable, protect patients from PBMs’ predatory pricing, and support the neighborhood pharmacies that Texans trust.

Editor’s Note: The above guest column was penned by RoxAnn Dominguez, Pharm.D., a licensed Texas pharmacist and chief executive officer of the Texas Pharmacy Association. The column appears in the Rio Grande Guardian with the permission of the author. 

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