The Cure is Worse Than the Disease: Arkansas’ PBM Law Shows Why Economic Amnesia Is Dangerous

<![CDATA[There’s an old saying in medicine: First, do no harm. In economics, we might borrow that line—if policymakers could just remember the harm they’ve already done.Arkansas’ now-paused attempt to ban pharmacy benefit managers (PBMs) from owning pharmacies wasn’t just misguided. It was an act of economic amnesia. And thanks to a federal judge’s injunction, we’ve been spared—for now—the consequences of another “cure” that ignores the disease.Let’s call this what it is: political frustration dressed up as reform—but aimed at the wrong target.Last week, U.S. District Judge Brian Miller issued a preliminary injunction against Arkansas' first-in-the-nation law targeting PBMs with retail pharmacy operations—companies like CVS and Express Scripts. The judge ruled that the law was likely discriminatory because Arkansas had not exhausted all other avenues before enacting its ban. In doing so, he not only protected 23 CVS locations from forced closure, but preserved access for thousands of Arkansas patients—especially in rural communities where options are already limited.That access was threatened by a narrative that ignores history. PBMs are not new. They have been around for decades and their role in American healthcare was expanded in response to growing federal involvement in healthcare—specifically, the 2003 creation of Medicare Part D. The government had just added a vast new prescription drug entitlement, and someone needed to manage the chaos of billing, reimbursement, and coverage across tens of millions of beneficiaries. ]]>