SB 2040/HB 1959 Could Eliminate Pharmacies Tennesseans Depend On – Without Lowering Drug Prices
By ALDP Co-Founders Michael Glassner and Jason Young
Prescription drug costs are a serious problem in Tennessee, patients and small businesses have told us time and again.
The moment Keezi saw the $600-a-month bill for two medications, he said to himself, “I don’t know what else to do at this point.” Keezi told us he went without, even though it has put his career on hold.
As drugmakers continue raising prices faster than inflation, patients struggle to afford essential medications. As President Trump has said, Americans “pay massively higher prices than other nations pay for the same exact pill, from the same factory.” That’s what needs fixing.
Instead, Tennessee lawmakers are considering SB 2040/HB 1959, which takes a different approach. Rather than addressing what manufacturers charge, the bill would mandate closures or fire-sales of pharmacies across Tennessee – including retail, mail-order, and specialty pharmacies serving thousands of patients.
Every Type of Pharmacy Matters
We believe every type of pharmacy fills an essential role: independent, chain retail, mail-order, and specialty pharmacies. Each serves different patient needs and community circumstances.
From our work, we know that seniors are more than 50% more likely than other adults to rely on mail-order services. Busy parents rely on drive-thru and extended hours at their neighborhood chain pharmacy. TRICARE beneficiaries depend on mail-order pharmacy at four times the rate of the general population. For people managing chronic conditions in rural areas – or anyone who can’t easily travel – mail-order service isn’t a convenience. It’s a lifeline.
Research shows:
- Chain retail pharmacies serve the majority of Tennesseans
- Independent pharmacies anchor small-town main streets
- Specialty pharmacies handle complex medications for cancer, HIV, and rare diseases that require specialized care
SB 2040/HB 1959 would force closures and sell-offs across three of these categories (mail-order, chain retail and specialty) based on ownership structure. That eliminates patient options, but it does not address affordability.
What SB 2040/HB 1959 Actually Does
Modeled after Arkansas Act 624 – which a federal judge has blocked – these bills prohibit pharmacy benefit managers from owning pharmacies in Tennessee. If the legislation becomes law, the State Board of Pharmacy would revoke or refuse to renew licenses for affected locations.
The practical effect: pharmacies close, mail-order services cease, and patients face uncertainty about where to fill prescriptions. Especially for patients taking multiple medications, any gap can mean missed doses and worsening health.
The legislation goes beyond “leveling the playing field” – it significantly tilts the field in favor of one business model over another. (In ruling on the Arkansas case, Judge Miller didn’t enjoin Act 624 because PBM reform is wrong, but because Arkansas crossed the line from regulation into economic protectionism.) We believe policymakers should be skeptical of any proposal that reduces competition in health care markets while claiming to help patients.
The Cost Problem Remains Untouched
Here’s what SB 2040/HB 1959 doesn’t do: it doesn’t change the prices drug manufacturers charge.
When someone with diabetes can’t afford insulin, pharmacy ownership structure isn’t the problem – the manufacturer’s list price is.
Tennessee voters want action on manufacturer pricing. Strong majorities – across party lines – support Prescription Drug Affordability Boards that review drugmakers’ prices and protect patients from unaffordable medications. These solutions target the actual source of the problem.
Who Gets Hurt
For patients, the details of ownership law can feel abstract. But the effects of this bill would show up in concrete ways.
Rural residents
Rural Tennesseans already face health care access challenges. If mail-order services shut down, patients may need to drive significantly farther to retail pharmacies – meaning more time away from work or family, real barriers for people with disabilities, and risks to medication adherence.
Seniors, Vets & Chronic Care Patients
For seniors who can no longer drive easily, veterans managing service-connected conditions, or patients with complex chronic diseases, disruption in pharmacy access can mean gaps in treatment. These aren’t abstract concerns. They’re predictable consequences of mandating closures without ensuring alternatives exist first.
People who rely on specialty care
Specialty pharmacy patients face even greater risk. Cancer treatments, HIV medications, and rare disease therapies require specialized handling and coordination. These aren’t medications available at any corner pharmacy.
a better path
We believe Tennessee wants to protect pharmacy access for vulnerable populations while addressing affordability. Evidence-based approaches that states have successfully used include:
- Addressing drug affordability directly. When states establish Prescription Drug Affordability Boards and empower them to set upper payment limits, they create more predictable economics for everyone – including rural patients and pharmacies.
- Supporting rural pharmacy operations. Some states have created grant programs, loan forgiveness for pharmacists in underserved areas, or technical assistance for independent pharmacies. These directly address rural pharmacy challenges without restricting which business models can serve communities.
These approaches don’t require retail pharmacy closures or mail-order service elimination.
Patients shouldn’t have to choose between pharmacy access and drug price relief. Tennessee can deliver both by targeting the companies setting unaffordable list prices rather than closing the pharmacies patients already depend on. We look forward to working with Tennessee policymakers, patient advocates, and community leaders on solutions that put patients first.
What Tennesseans can watch – and do – next
SB 2040/HB 1959 is still moving through the legislative process. As lawmakers debate, Tennesseans can:
- Pay attention to hearings, amendments, and updated impact estimates on how many pharmacies and patients might be affected
- Ask questions about how any changes will be phased in and how continuity of care will be protected
- Share their own experiences with drug costs and pharmacy access – especially if they rely on specialty, mail‑order, or rural pharmacies
For more on drug prices and pharmacy access in Tennessee – and to share your story – visit our Tennessee hub at lowerrxprices.org/state/tennesseerx/.