Washington, D.C. – In response to the news that Arkansas Gov. Sarah Huckabee Sanders signed into law HB 1150, a structural separation law that prohibits pharmacy benefit managers (PBMs) from owning pharmacies, the American Economic Liberties Project released the following statement.

“Arkansas is the first state in the nation to break up the Big Medicine conflicts of interest that drive prescription drug costs up, quality down, and independent pharmacists out of business,” said Benjamin Jolley, PharmD, Senior Fellow for Healthcare at the American Economic Liberties Project. “We applaud state lawmakers and Governor Sanders for enacting this common-sense legislation to ensure that the largest PBMs can’t steer business to their own pharmacies at the expense of vulnerable patients, taxpayers, employers, and the general public. We also urge other states and Congress to follow Arkansas’ lead by passing similar legislation immediately. Each day of delay needlessly puts patients’ lives at risk.”

PBMs are middlemen who negotiate prescription drug benefits on behalf of health plans with drug manufacturers and pharmacies. The “Big Three” PBMs – CVS Caremark, Cigna Group’s Express Scripts, and UnitedHealth Group’s OptumRx – control nearly 80% of U.S. prescription drug claims. They leverage this market power to demand untenably low reimbursement rates from independent pharmacies in exchange for inclusion in their networks. Many pharmacies accept these rates for fear of losing access to a large share of their customer base. But these rates are accelerating the pharmacy closure epidemic. Economic Liberties research shows that at least 25 Arkansas pharmacies closed between January 2024 and February 2025.

HB 1150 mirrors the Patients Before Monopolies Act (S.5503, H.R. 10362), introduced by Sens. Elizabeth Warren (D-MA) and Josh Hawley (R-MO) and Reps. Jake Auchincloss (D-MA-04) and Diana Harshbarger (R-TN-01) late last session. This federal legislation would force insurers and PBMs to divest their pharmacy businesses within three years, eliminating the conflicts of interest inherent to their common ownership.

Learn more about the Break Up Big Medicine initiative here.

Learn more about Economic Liberties here.

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The American Economic Liberties Project works to ensure America’s system of commerce is structured to advance, rather than undermine, economic liberty, fair commerce, and a secure, inclusive democracy. Economic Liberties believes true economic liberty means entrepreneurs and businesses large and small succeed on the merits of their ideas and hard work; commerce empowers consumers, workers, farmers, and engineers instead of subjecting them to discrimination and abuse from financiers and monopolists; foreign trade arrangements support domestic security and democracy; and wealth is broadly distributed to support equitable political power.