Arkansas PBM Legislation: What Independent Pharmacy Owners Need to Know About Act 624 and the Road Ahead

First Financial Bank

Arkansas was the first state to outlaw Pharmacy Benefit Manager (PBM) owned pharmacies under Act 624, which quickly made its way through the pharmacy sector.

For independent pharmacy owners across Arkansas and nationwide, keeping up with those shifts is the best way to prepare their business for what’s next. We interviewed two experts with extremely significant perspectives. Bobby Glaze, Pharm.D., is a lender at First Financial Bank who works directly with independent pharmacy owners. John Vinson, Pharm.D. serves as CEO of the Arkansas Pharmacists Association.

Together, they describe what Act 624 means today and what it might mean for independent pharmacies’ future.

Understanding Act 624: More Than a Ban.

Act 624 deals with an inherent conflict of interest in the pharmacy industry. As John Vinson discusses, “The purpose of Act 624 is to remove the conflict of interest created when PBMs act as both price setters and price takers. This inherent conflict of interest drives up costs by billions for patients, employers, and taxpayers. More importantly, it threatens the health and safety of the citizens of Arkansas.” The numbers are striking. “Currently, 70% of all brand specialty drugs in the United States, representing over $300 billion in annual spending, are filled at just three pharmacies owned by the Big Three PBMs,” Vinson explains. “Recent Federal Trade Commission PBM studies show that prices on these prescriptions are being marked up by billions compared to non-PBM-owned pharmacies.”

“These business tactics are monopolistic and have devastated the community pharmacy market,” says Vinson. He cites one example: “Charging $19,200 for a cancer drug at a PBM-owned pharmacy and steering or forcing the patient there when that same drug should cost $97 at the local cancer treatment center is criminal. These conflicts have led to worsened outcomes in colon cancer, brain cancer, and leukemia.”

Current Legal Environment.

Understand the legal situation before making major decisions in your business under Act 624. “Act 624 is currently being challenged legally in federal court by four national PBMs and the national trade association PCMA,” Vinson notes. “The law may not be implemented until the federal court system makes a final decision on the merits of the case. I would not advise making major financial decisions based solely on Act 624 at this time, but it should certainly be closely watched along with similar laws being introduced in other states across the country next year.”

Where the Real Opportunity Will Be.

Glaze and Vinson have concerns about potential pharmacy deserts, but they both see opportunities ahead. “The key to expansion in underserved areas won’t be from the closure of brick and mortar PBM-owned locations, but from the opportunity of bringing mail order prescriptions back to the community,” Glaze says. “When patients aren’t forced to go to the mail for the prescriptions, they can support local independents that have a vested interest in not only their health, but also the community they serve. This presents the largest opportunity for underserved areas and the opportunity for expansion.”

Vinson agrees, especially through specialty medications. “Our cancer treatment centers would welcome the day when 70% of required therapies are no longer forced or coerced to mail order PBM affiliates with higher costs, delayed access, and poor patient service reviews,” he says.

The legislation does not require PBM-owned pharmacies to shut down. “The law also does not require a PBM-owned pharmacy to close,” Vinson clarifies. “It requires a choice and decision on being a pharmacy or a PBM middleman. If patient care and profitability for pharmacies are healthy, you would think these companies would just give up their middleman contracts in Arkansas and remain open as pharmacies. There are over 45 licensed PBMs in Arkansas and more than 40 more in other states willing to fill the PBM gap so that the pharmacies can remain open.”

What This Means for Current Independent Pharmacies.

Act 624 for existing independent pharmacy owners enables strategic expansion. “These changes have the potential for growth opportunities for existing independents, but also for new independents to fill gaps in the care network,” Glaze says. “Patients won’t only be displaced from PBM brick and mortar stores, but also some from mail order pharmacies as well. This presents a huge opportunity for independent pharmacies to fill those gaps. This is a key point to look at expansion, even if it is just expanding your current staff and services to provide better care for the influx of patients if these changes go into effect.”

The trick is that you need adequate working capital, accessible or available, to obtain new customers. This could involve examining your current pharmacy loan structure or having a comprehensive business plan for growth. Some pharmacies may need to change their business models to accommodate specialty and rare medications previously handled by PBM pharmacies. “Financing, contracting, purchasing, and inventory management skills will need to evolve to support increased brand and specialty volume,” Vinson notes. “This may also require new licenses and expanded lines of credit.”

Risk and opportunity.

Bobby Glaze at First Financial Bank sees regulatory uncertainty as a backdrop to which good planning requires savvy investment: Regulatory uncertainty is about context, not a deterrent. “I don’t feel the law changes the outlook from a lender’s perspective,” Glaze explains. As a lender, we will continue to make loans that make sense. We invest in borrowers that come to us with a great business plan, an understanding of the market and the opportunities, and knowledge of the market and the business of pharmacy.”

“At First Financial, we are investing in you as a business owner,” Glaze makes it clear. “We always want to make sure to put our borrowers in a position to succeed and prosper.”As a lender, this can vary depending on multiple factors, including the size of the displaced patient population, the overall mix of brand drugs being dispensed, and how quickly you expect to grow,” Glaze says. “The last thing a new pharmacy wants is to see rapid growth and not have enough working capital to sustain rapid expansion. I believe a good starting point in terms of working capital would be somewhere between $400,000 and $600,000, depending on these factors.” This is consistent with the industry standard for setting up an independent pharmacy.

Evaluating Loan Applications in This Environment

First Financial Bank takes a multi-pronged approach when screening loan applications. “As a lender, we have to evaluate multiple factors when it comes to making a loan,” Glaze explains. “The first is making sure a borrower has a solid business plan as their foundation. Understanding the market opportunity and how to capitalize on it is key. Understanding both patient care and the business side of pharmacy is key and plays a crucial role in creating success long term.”

“I look at the passing of key legislation as a huge upside for pharmacy owners in Arkansas to ensure that they are paid fairly and sustainably,” Glaze says. “No law is perfect, and owners must take an active role in managing day-to-day operations to ensure profitability.”

Beyond Arkansas: National Implications

Other states – including Indiana, New York, New Jersey, and Vermont – are taking similar action. If Arkansas’s model goes nationwide, independent pharmacy owners should consider financial planning.

“First Financial Bank will continue to foster strategic partnerships nationwide,” Glaze says. “As a pharmacy-centric leader, we have the unique ability to understand these opportunities that arise when changes like this happen in the market. Understanding how changes like these affect pharmacies helps us as lenders and partners to position our customers for success.”

He emphasizes the importance of preparation: “Understanding that these legislative changes can lead to the opportunity for growth of the Independent Pharmacy. The key to growth is making sure stores have a financial plan to have enough working capital either on-hand or accessible to be able to take on new customers and seize this opportunity.”

Practical Advice for Independent Pharmacy Owners

What should independent pharmacy owners be doing now? Both specialists have clear guidance. “Join your state pharmacy association and invest financially to strengthen it,” Vinson advises. “These investments are investments in yourself, your profession, and your patients. We have made great progress, but there is still important work to do in court, enforcement, and future legislative reform.”

He continues: “Join and support your preferred national associations, including the National Community Pharmacy Association. Relationships matter. Get to know trusted colleagues in the profession, including banking industry partners. Learn the laws and the opportunities that help you protect and serve your patients.”

Vinson also suggests that educational offerings such as the NCPA Ownership Workshop are great jumping-off points: “It is also a good idea to consider partnerships with pharmacy owner groups and to recognize the power of relationships in helping you grow as both a clinician and a business professional. Talk with people in the industry who have experience and earn their trust. The NCPA Ownership Workshop is also an excellent place to start from an educational standpoint.”

Moving Forward with Confidence

Changes in Arkansas signal more than one state’s approach to PBMs. This fundamentally changes the way the pharmacy industry could operate. Although legal challenges have created short-term uncertainty, momentum for pharmacy reform continues to accumulate at the state and federal levels. As independent pharmacy owners, this moment of great need requires thoughtful planning, powerful networks, and relationships with financial institutions that know pharmacy.

If you are thinking about opening your first pharmacy, expanding operations or keeping up with industry trends, please consult an advisor or other professionals in that field. At First Financial Bank, we’ve provided independent pharmacy owners with financial resources to navigate regulatory changes, market shifts, and growth opportunities. Say hello, we’d love to hear from you.

Have questions or comments? We’d love to hear from you.

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