AND ACCESS FOR ALL: Ryan Gehrig (center), president of Mercy Arkansas Hospitals, and Troy Wells, (at right) president and CEO of Baptist Health, prepared to testify Jan. 22, 2025, on a bill to allow nonprofit hospitals in Arkansas to operate retail pharmacies. The bill was signed into law as Act 52 of 2025. | Mary Hennigan/Arkansas Advocate
By TESS VRBIN | Arkansas Advocate
Arkansas lawmakers overwhelmingly approved three laws during the 2025 legislative session meant to increase patients’ access to prescription medication.
One of those laws has since been blocked in federal court, but the other two will go into effect Tuesday.
Act 52 removes the state’s ban on nonprofit hospitals holding pharmacy permits. Supporters of the law, including some of the state’s largest hospital systems, said patients should benefit from hospital pharmacies’ capacity to afford more expensive drugs and remain open at all hours compared to local independent pharmacies.
Additionally, Act 630 prohibits drug manufacturers from restricting the availability of medication to a “limited distribution network of out-of-state pharmacies.”
Republican Rep. Brandon Achor of Maumelle, a practicing pharmacist and the lead sponsor of Act 630, said in an interview that manufacturers have the power to limit which pharmacies can purchase their drugs. He called this “a huge public safety issue,” especially when the availability of some drugs is limited to mail-order pharmacies.
“These patients should not be contingent on an airplane or a FedEx truck,” Achor told a House committee in March. “They should be contingent on being able to access [pharmacies] in real time.”
Achor was a co-sponsor and vocal supporter of Act 624 of 2025, which would have banned pharmacy benefit managers (PBMs) from holding a permit to operate a drug store in Arkansas after Jan. 1, 2026. PBMs negotiate prescription benefits among drug manufacturers, distributors, pharmacies and health insurance providers, and the biggest ones also own pharmacies and insurers.
A federal judge temporarily blocked Act 624 in July after four PBMs and the Pharmaceutical Care Management Association filed lawsuits against it. Supporters of the law said it would prevent PBMs from financially straining local pharmacies to the point of forcing them to close, but U.S. District Judge Brian Miller ruled that the law “likely violates” the U.S. Constitution’s commerce clause. The state filed a notice of appeal with the court on Thursday, and both plaintiffs and defendants asked Miller to stay further proceedings until the appeal is decided.
The Arkansas Pharmacists Association supported Act 624. CEO John Vinson told a Senate committee in April that Act 52 will create new pharmacy jobs that could make up for any job loss brought about by Act 624.
The initial version of Act 52 would have simply removed the portion of state code banning hospitals from having retail pharmacies. It failed in committee in January after Vinson and others expressed concerns that competition from hospitals’ in-house pharmacies could snuff out independent pharmacies. A 2023 bill similar to Act 52 did not advance in the Legislature.
Lawmakers amended the eventual Act 52 to replace the deleted code with specific provisions, such as allowing the State Board of Pharmacy to issue permits for retail pharmacies within 250 yards of a nonprofit hospital’s physical location in Arkansas, plus one additional pharmacy permit per 100 beds in the hospital.
Additionally, Act 52 does not place a limit on the number of retail pharmacies that nonprofit hospitals could operate in conjunction with infusion centers, and it allows these hospitals to direct their pharmacies’ services to underserved areas.
Projected impacts on patients
The Arkansas Pharmacists Association was neutral on the final version of Act 52. Vinson said in an interview last week that the combined impact of Acts 52, 624 and 630 “will benefit a whole lot more people than just this one law alone.”
“It’s not just [about] how many pharmacies there are, but [whether] the patients have a fair market where they can access drugs at the lowest cost where they want to, rather than where a fox guarding the henhouse forces the patients to a pharmacy they don’t want to use through the mail at a higher price,” Vinson said.
Vinson and independent pharmacists have repeatedly denounced PBMs’ ability to set their competitors’ prices and steer clients to their own affiliate pharmacies. They have also claimed PBMs routinely break or skirt around Arkansas’ existing laws meant to regulate them.
Act 900 of 2015 required PBMs to pay pharmacies at least the national average of what drugstores pay wholesalers for drugs, and two 2018 laws prohibited PBMs from reimbursing their affiliated pharmacies in Arkansas at a higher rate than their locally owned competitors.
Three pharmacy benefit managers — OptumRx, Express Scripts and CVS Caremark, all of whom sued Arkansas over Act 624 — manage 79% of prescription drug insurance claims for approximately 270 million people, according to a July 2024 Federal Trade Commission report.
Vinson noted that even if Act 624’s lack of enforcement means nonprofit hospital pharmacies can’t provide patients with specific drugs, the existence of those pharmacies due to Act 52 still broadens patient access to other drugs.
Administrators from Baptist Health and Mercy Arkansas Hospitals both expressed support for Act 52 before lawmakers in January.
Baptist does not plan to submit an application for a retail pharmacy permit immediately but still “broadly supports the concept that hospitals should have that opportunity to fulfill the need” for more accessible medications, particularly for infusion drugs, said Jordan Burgess, Baptist’s vice president of government relations and public affairs.
Meanwhile, the Southwest Arkansas Regional Medical Center is in the process of becoming a nonprofit hospital, said Clay Hobbs, chief operating officer of Pafford Health Systems, the locally-owned medical service company that runs the hospital in Hope.
The hospital plans to take advantage of Act 52 upon becoming a nonprofit, and providing reliable access to prescription drugs in an area with few existing pharmacies will be a “great opportunity for our rural communities” in Southwest Arkansas, Hobbs said.
The State Board of Pharmacy is required to process pharmacy permit applications within a month of receiving them, and processing includes an on-site inspection of the facility, board executive director John Kirtley said in an email.
CARTI Cancer Center has 18 locations statewide, including 11 licensed pharmacies. Some of those locations are limited in what cancer drugs they can provide thanks to limited distribution networks, and Act 630 will alleviate that, CARTI CEO Adam Head told a House committee in March, speaking in favor of the legislation.
The only opponent of Act 630 before the Legislature was Pharmaceutical Research and Manufacturers of America, a trade organization representing drug manufacturers. PHRMA supported the intent of the legislation but wanted more time “to make sure there’s no harm with this new [drug] delivery system,” Sharon Lamberton, the organization’s deputy vice president of state policy and external outreach, told the same House committee.
However, Act 630 will make it easier for the University of Arkansas for Medical Sciences to provide patients with specialized cancer drugs, including those from clinical trials in which UAMS participates, spokesperson Leslie Taylor said Friday.
“We’re able to get them during the clinical trials, but then once we’ve done our part to help with this, that’s over with, and we have trouble accessing the drugs directly,” Taylor said.