Every day behind the pharmacy counter I see the consequences of a system that quietly steers my patients away from me.

A longtime patient of mine recently came into my pharmacy confused because their copay had suddenly doubled. Their options: pay the increased charges for the same medication or switch to a pharmacy owned by their pharmacy benefit manager (PBM). Another patient told me their prescription was transferred without them realizing it. Others are pushed toward mail-order medications that sit in the Arizona heat after delivery, even when they’d prefer to pick them up from a local pharmacist whom they know and trust.

This isn’t cynical. It’s how the system is designed, and it doesn’t work for patients.

Senate Bill 1458 would help to change that. It’s one of the most meaningful patient-first reforms Arizona has considered in years — not just for patients, but for pharmacists like me trying to do right by them.

PBMs were originally created to process prescription drug claims. Today, the three largest PBMs have effectively created a monopoly by controlling roughly 80% of the market — and they don’t just manage benefits anymore. They own insurance companies, pharmacies, and mail-order pharmacies they steer patients toward. That vertical integration means they can decide where a patient fills a prescription, how much they pay, and how much I’m reimbursed — if I’m allowed to serve them at all.

A recent Arizona Capitol Times commentary written by three Chamber of Commerce CEOs argued against this bill. I find it ironic that in doing so, they advocate for PBM monopoly control that would harm locally owned businesses, and in some cases, force them to shut entirely. I’m unclear how that reality could be supported by groups whose whole purpose is to advocate for a robust business environment in their areas.

I’ve had patients ask why I can’t match the price they’re being offered elsewhere, not realizing that the PBM sets both prices — and often pays its own pharmacies more for the exact same prescription. I’ve had to tell longtime patients that because of their insurance, they’ll pay more to stay with me. No pharmacist should have to have that conversation.

SB 1458 doesn’t eliminate PBMs or their role in the system. It simply draws a fair line: they cannot use their control over patient data and pricing to participate in the anti-competitive behavior of steering business to themselves.

The bill restores basic protections that should exist already but sadly don’t. It stops PBMs from using patients’ prescription history to market their own pharmacies. It requires patients’ written consent before their prescription can be transferred. It prevents PBMs from paying their own pharmacies more than independent pharmacies for the same drug. And it ensures patients aren’t penalized with higher copays just for choosing the in-network pharmacy they trust.

These aren’t theoretical problems. The Federal Trade Commission has documented PBM practices like self-preferencing, patient steering, and the commercial use of prescription data. I’ve watched the impact firsthand as independent pharmacies across Arizona — especially in rural areas — close their doors.

When that happens, patients don’t gain convenience. They lose access to care.

They lose the pharmacist who caught a dangerous drug interaction. The one who explained how to take a new medication. The one who noticed when something wasn’t right and picked up the phone to call a doctor. The pharmacy that sees them face to face and knows who they are and what they need. No mail-order delivery, especially in the middle of an Arizona summer, can replace that.

Opponents of SB 1458 argue it will raise costs or limit employer flexibility. But the bill doesn’t mandate benefit designs or eliminate tools like formularies, networks, or mail-order options. Those remain intact.

What it does address is a hidden cost driver: PBMs overpaying their own pharmacies while squeezing others out. Requiring equal reimbursement for the same prescription isn’t radical — it’s the foundation of fair competition.

PBMs will still be able to communicate with patients and offer options. They just won’t be able to tilt the playing field using the very data and control they’ve been entrusted with.

From where I stand, this bill is about more than policy. It’s about whether I can continue to serve my patients without being systematically pushed out of the picture so a CEO who doesn’t even live in Arizona can make more money.

Patients should be able to choose their pharmacy. Local pharmacies should be able to compete on a level playing field. And no one’s health care decisions should be quietly shaped by behind-the-scenes financial incentives of middlemen.

SB 1458 moves us closer to that reality.

Jason Dykstra is the owner of Chino Valley Pharmacy.