Low-income Americans are being squeezed by rising health care costs, and the Trump economy isn’t making things any easier on families who are trying to afford basics like housing, groceries, and gas, which recently approached an all-time high.
Prescription drugs only make up a portion of overall healthcare spending, but their high cost is a pain point for many. For years, Consumer Action has supported legislation and other efforts to lower drug prices, including the Affordable and Safe Prescription Drug Importation Act to allow importation of low-cost drugs from Canada.
Americans face a prescription drug crisis on two fronts, hitting people with the least money hardest. For families on fixed incomes, especially seniors, annual price hikes from drugmakers mean making cuts elsewhere. Simultaneously, SNAP (food stamp) benefits are seeing their steepest decline in decades, due to deep cuts in federal spending, and food prices keep rising, leaving Americans struggling to afford necessities left and right.
Second, places where people get their medicines, pharmacies, are disappearing in communities that can least afford to lose them. From 2019 to 2024, thousands of pharmacies closed across the country, and now tens of millions of Americans live in “pharmacy deserts” where filling a prescription requires a long drive or a delivery service.
For families in the South, pharmacy deserts exist alongside food deserts, with big portions of the population in states like Mississippi, Arkansas, Louisiana, and Tennessee living without reliable access to a supermarket. Additionally, these same states have some of the highest levels of poverty in the country, with Black and Hispanic families more than twice as likely to be below 125% of the poverty line.
In an attempt to fix the prescription drug problem, some of these same states are adopting policies that could unintentionally deepen existing inequalities.
Specifically, Republicans in Arkansas and Tennessee have passed laws that prohibit the same company from owning both pharmacies and a Pharmacy Benefit Manager (PBM). PBMs, like CVS Caremark and Express Scripts, are the companies that negotiate prescription drug prices and access.
It is important for consumers to have corporate power curbed. But in practice, the AR and TN bills risk mass pharmacy closures that will seriously impede access for vulnerable communities. In Tennessee, for example, well over 100 pharmacies are expected to close once the legislation goes into effect. It is unclear how the public health system will absorb the million or more patients that will be left with little access to a pharmacy.
Pharmacy deserts already disproportionately impact Black, Hispanic, Native American, low-income, and rural communities. 38% of Black and 36% of Hispanic neighborhoods are pharmacy deserts already, compared to only 27% of White neighborhoods. On average, people in pharmacy deserts are more likely to be less educated, less proficient in English, and have lower insurance coverage.
Research says pharmacy closures lead to people taking their medication less often, rationing pills, or skipping altogether.
Already near the bottom on several public health statistics, Arkansas and Tennessee illustrate that legislative intervention can backfire on the very communities most in need. Pharmacy closures mean fewer places to get your flu shot, fewer places to ask a medical question, and make structural barriers to health care even higher.
For low-income communities, communities of color, and seniors, this is an unacceptable trade-off.
There is a better path. States can pair PBM reform, such as ensuring that negotiated savings are passed on to patients, with state Prescription Drug Affordability Boards (PDABs) that can review the cost of high-priced medications and set upper payment limits. Eleven states already have.
For example, Colorado’s Affordability Board put a price cap on one drug that is estimated to save the state’s payers $32 million per year. Expanding that to many egregiously priced drugs could save patients and taxpayers hundreds of millions each year.
Ensuring access to reliable internet in rural and underserved communities could also fill some of the pharmacy gaps through telemedicine and telepharmacies (remotely dispensing pharmacies). Expanding mail order delivery of some medications could help those without a local pharmacy, but it won’t solve the problem for those with an urgent need for a prescription.
Pharmacy closures in Tennessee or Arkansas won’t cut a cent from the price of insulin or cancer drugs, but it does make the existing problem of pharmacy deserts worse, especially for Black and Brown neighborhoods, rural towns, and seniors.
If lawmakers are serious about helping consumers, they should crack down on prices, keep pushing for transparency, and make the communities in need the center of future reforms.
Ken McEldowney is a Senior fellow at Consumer Action, a nonprofit organization that empowers underrepresented consumers nationwide to assert their rights in the marketplace and financially prosper.
