Texas pharmacies are disappearing across the state affecting at least 4 million residents of the state.
According to the Texas Pharmacy Association, the state has struggled with closures for the past decade leaving 60% of counties with no pharmacy in 2023. One pharmacy we week is closing in the state.
Across the country, 2025 data was showing 2002,200 closures, with CVS chains closing 270, Walgreens, 500-plus and Rite Aid finalizing liquidation of all remaining stores. Hundreds of independent and smallchain pharmacies also closed. Roughly 1 in 3 retail pharmacies have closed since 2010.
Independent pharmacists say financial challenges are largely due to benefit managers or PBMS, which are usually listed on patient’s insurance cards. PBMs negotiate drug prices for large employers and insurance companies and maintain the list of drugs that are covered by insurance plans, giving PBMs control over how much money a pharmacy can make per prescription. Reimbursement rates for prescriptions are causing pharmacies to sell at a loss.
An example is an insulin prescription that costs $414.21 reimbursed at a rate of $403.16, costing the pharmacy to lose $11.05. It adds up with multiple prescriptions.
The exchange between a PBM and pharmacy begins when a customer hands their insurance card to the pharmacist when the customer pays for a prescription. PBMs have already determined how much the insurer and customer is paying for the drug and how much the pharmacy is reimbursed for selling the drug.
The three biggest PBMs in the country are CVS Caremark, Optum Rx and Express Scripts, controlling 80% of all prescription claims in the US. In 2025, the parent companies of these three were included in the top 13 companies on the Fortune 500, which ranks the largest U.S. companies by revenue. According to an Optum Rx statement, pharmacy is the most accessed benefit in health care, and community and independent pharmacies are essential care providers, particularly in rural and underserved communities. Optum Rx says it supports these through cost-based reimbursement aligned to manufacturer pricing actions.
CVS Caremark reported saving its clients $45 billion in costs. CVS employs more than 28,000 Texas and operates 750 pharmacies, generating $46.9 billion in economic activity per year. In the state.
Rural pharmacies are most affected by the loss of profit due to their lower revenue streams compared to corporate and urban pharmacies, forcing them to expand into other businesses and gift shops to stay afloat. According to Ohio State University research, a lack of pharmacy means having less consistent access to medications, vaccinations and pharmacist-led care – and also worse medication adherence, leading to more severe chronic conditions and overall health outcomes. Texas lawmakers have passed several laws impacting the relationship between PBMs and pharmacies, but they’ve done little to address the core issue of fairer PBM reimbursement rates.
One bill, passed last year, provides protections for pharmacies in their contracts with PBMs. Another, also passed last year, prohibits “gag clauses,” which previously prevented pharmacists from informing patients if their medication was more affordable to obtain elsewhere.