Arizona lawmakers have never been content to follow Washington, D.C., or other states when patients need care. From first-in-the-nation reforms to ease regulatory burdens on out-of-state telehealth providers and streamline licensing for medical professionals, to launching a national movement around patient autonomy with Right to Try, Arizona’s policymakers have acted boldly to protect and expand access to care.

Lawmakers should remember that trailblazing history before revisiting Senate Bill 1545, a proposal that could force some pharmacies to stop serving patients. SB 1545 would prohibit pharmacy benefit managers, or PBMs, from holding a direct or indirect interest in a retail pharmacy. 

Under the reform, the Arizona Board of Pharmacy would be directed to revoke or refuse to renew permits for pharmacies that do not comply. Most tellingly, the bill requires affected pharmacies to notify patients and their doctors that they will no longer be able to dispense retail prescriptions after the law takes effect. Because major pharmacy benefit managers are directly owned by or integrated with major healthcare and retail pharmacy chains, the legislation effectively seeks to ban many well-known chain pharmacy counters from dispensing retail prescriptions in the state.Pharmacy access is already a serious problem in Arizona. Nearly 1.2 million Arizonans live in pharmacy deserts, while hundreds of thousands more rely on a single “keystone” pharmacy whose loss could leave their community without reasonable access.

For patients in Apache and Navajo counties, filling a prescription may already require a lengthy drive. For an older patient, a family without reliable transportation, or someone managing diabetes or another chronic condition, an additional hour on the road is not a minor inconvenience. It may be the difference between taking medication and going without it.

Pharmacies also provide far more than prescriptions. They administer vaccines, answer questions about side effects and drug interactions, help patients manage chronic conditions, and provide care during evenings and weekends when many doctors’ offices are closed. Research has linked pharmacy closures to lower medication adherence and fewer prescription fills, meaning that losing a pharmacy can directly affect whether patients remain on medicines that keep them healthy and out of the hospital.

The impulse for reform is understandable. PBMs help determine which drugs are covered, how pharmacies are reimbursed and which pharmacies participate in a plan’s network. When a PBM can design a network and benefit from an affiliated pharmacy, concerns may arise that it could steer patients or disadvantage competitors. The industry should not be exempt from legislative attention. But a real problem does not make every proposed solution the right one.

An ownership ban targets a business structure instead of the conduct causing harm. It does not distinguish between a pharmacy that mistreats competitors and one that provides reliable, affordable care in an underserved community. Nor does a change in ownership guarantee that another operator will buy every affected pharmacy, retain its employees or continue serving the same patients.

Arkansas adopted a similar ownership ban, but a federal judge blocked it before it could take effect, concluding that the challengers were likely to succeed on their constitutional claims. Tennessee enacted its own structural separation law this year and already faces multiple federal lawsuits challenging it on constitutional and federal-preemption grounds. Those cases have not yet been decided, but they reinforce the legal and operational uncertainty surrounding this approach. Arizona should not invite years of litigation and immediate disruption while patients and providers try to determine where prescriptions will be filled.

Arizona can take a better path. Lawmakers can prohibit patient steering, require meaningful disclosure of reimbursement practices, strengthen network-adequacy protections and impose serious penalties for retaliation or unfair dealing. They can also pursue reforms that make it easier for pharmacies to open and remain viable in underserved communities. Pharmacy reform should confront genuine obstacles while expanding options for patient access and care.

Arizona became a national healthcare leader by opening doors. Policymakers should not reverse course now. Arizona has earned a national reputation for pioneering access, not slamming the healthcare access door shut.

Naomi Lopez is a senior fellow in healthcare policy at the Goldwater Institute and author of The Free Market Remedy for Drug Pricing Ills: A Toolkit for State Lawmakers.