Texas lawmakers face a choice. They can pursue serious reforms that lower prescription drug prices for working families, or they can follow other states into policymaking that leaves patients worse off.
Unfortunately, some are choosing the second path.
A growing faction in Austin wants to wage war on pharmacy benefit managers by targeting pharmacies affiliated with PBMs. State Representative Tom Oliverson has emerged as one of the most aggressive advocates of this strategy, promoting policies that would help push PBM-linked pharmacies out of Texas.
Texans should ask a basic question before supporting sweeping regulation: who benefits if pharmacies close?
Certainly not patients. Nor veterans. Not rural families. And certainly not working Texans currently struggling with healthcare costs.
Texas already has a pharmacy access problem. Millions of Texans live in communities with limited access to pharmacies. Rural counties are particularly vulnerable. In many places, a single pharmacy serves an entire community. If that location disappears, access disappears with it.
We have seen what happens when lawmakers prioritize political theater over practical economics. Arkansas and Tennessee pursued aggressive anti-PBM legislation marketed as a way to restore fairness. In reality, those efforts threatened jobs, disrupted pharmacy networks, and introduced massive regulatory uncertainty into healthcare markets.
That is not free-market reform, it is government micromanagement, and conservatives should reject that approach.
The real driver of high drug prices is hiding in plain sight. Big Pharma sets the prices. Drug manufacturers determine launch prices. They decide annual price increases. They control the upstream cost structure that every employer, insurer, pharmacy, and patient ultimately pays. Yet, somehow the conversation keeps shifting away from manufacturers and toward everyone else.
Instead of trying to regulate pharmacies out of existence, lawmakers should attack inflated drug prices directly through a Prescription Drug Affordability Board. A PDAB gives Texas something it currently lacks: a mechanism for independent review of excessive drug pricing. These boards analyze which drugs create the greatest affordability burdens, identify unjustified price hikes, and can establish payment limits to prevent price gouging from spreading through the system.
A properly designed PDAB would protect Texas employers from unsustainable healthcare spending. It would protect public programs from rising costs. And it would give patients relief by confronting the source of unaffordable medicines. Most importantly, it addresses the root cause. That is what smart policy looks like.
Representative Oliverson’s anti-PBM crusade may generate headlines, but it does not solve the affordability crisis. Closing or restricting pharmacies because of corporate ownership structure is not serious cost containment, but merely symbolic politics. Texas should be focused on preserving pharmacy access while increasing accountability where it matters most. That means enforcing PBM transparency rules already on the books. It means protecting fair reimbursement, and it means holding pharmaceutical manufacturers accountable when they abuse pricing power.
Texas can either copy failing states or chart a better course. The Arkansas and Tennessee model offers more regulation, fewer choices, and greater instability. Texas should choose competition, access, and accountability.
The goal is not to punish pharmacies. The goal is to make medicine affordable. A PDAB gets Texas closer to that goal. An anti-PBM crusade does not.
Dominic Arzon serves as the Deputy Director of the Private Property Rights Institute.