When a community pharmacy closes, patients can lose access to medications, communities can become pharmacy deserts, and pharmacy staff face increased stress and uncertainty. Yet across the US, pharmacy closures continue to rise despite a decade of efforts aimed at addressing financial pressures. Pharmacy benefit managers (PBMs) influence medication reimbursement and are frequently cited as contributors to financial strain. States have enacted legislation to regulate PBM practices.

This article examines how state policies regulating pharmacy benefit managers have evolved over the last decade and how pharmacy stakeholders perceive the factors contributing to pharmacy closures.