CVS wrote the rules. Tennessee is rewriting them.

Today’s political climate is defined by soaring polarization, corporate capture and politicians who too often put donors and special interests before the people they serve. I saw it (and lived it) during my four years as Chair of the Tennessee Democratic Party.

But the FairRx Act is different. In the face of a fierce corporate pressure campaign, legislators on both sides of the aisle stood up for Tennesseans struggling to afford and access prescription drugs.  

The FairRx Act will prohibit Pharmacy Benefit Managers, PBMs, from owning or operating pharmacies in Tennessee. PBMs are middlemen that negotiate drug prices between manufacturers, insurers and pharmacies, but these middlemen have been taken over by corporate giants.

Companies like CVS Health–who own drug manufacturers, PBMs, pharmacies, and providers control over 80% of the market, giving them complete authority over the pricing, reimbursement and distribution of prescription drugs. As bill author Sen. Bobby Harshbarger, a Kingsport Republican, said “the one that sets the reimbursement rules cannot also own the pharmacy being reimbursed.” 

The concentration of power lets companies determine reimbursement rates that favor their own pharmacies over independent competitors, restrict patient access to outside options and jack up costs for Tennesseans who depend on life-saving medications. 

Tennessee passes bill targeting pharmacy benefit managers. CVS plans to sue. 

The FairRx Act doesn’t just inconvenience CVS, it threatens their entire business model. CVS calls it vertical integration, but monopolization is a more accurate term. By making CVS choose a single role in the pharmaceutical network, this landmark legislation introduces two things the company is terrified of: fair competition and affordable medicine.

As evidence of their trepidation, CVS went to extraordinary lengths to ensure this bill never becomes law.

CVS used just about every tool available to oppose the FairRx Act:over $4 million on ads, mass texts to customers, paper signs in stores, paid social media influencers and an army of lobbyists working the statehouse. And while CVS ran its public campaign, a separate dark money group has spent at least $500,000 more in attack ads hammering legislators supporting the bill, with no disclosure of who was funding them.

But most strikingly (and disturbingly) CVS threatened to close all 134 of its Tennessee pharmacy locations if the bill passed. CVS’ repeated failed attempts at public persuasion, influence peddling, and fear mongering have exposed where their priorities lie. They would rather keep prices sky-high, cut off patients from their pharmacies and put thousands out of work than surrender a profit model built on rigging the game. 

And it’s also a lie: When the FairRx Act is signed into law, Tennesseans will not suddenly be without access to pharmacies, and CVS won’t simply lock their doors and leave. Instead, if CVS chooses to remain a PBM rather than own a pharmacy chain, it will undoubtedly sell off its pharmacies to new owners who will continue to provide pharmacy access.

CVS blankets Tennessee airwaves, enlists mass texts to fight Pharmacy Benefit Manager bill

Intimidation is a familiar tactic for CVS. This January, the U.S. House Judiciary Committee concluded that CVS spent years threatening independent pharmacies and attempting to eliminate competing digital pharmacy hubs that jeopardized their PBM market-dominance. When these digital hubs showed up with tools to help independent pharmacies compete with the big chains and give patients real transparency and better prescription drug access, CVS swooped in, rewrote their own rulebook and drowned independent pharmacies in audits and legal threats unless they agreed not to work with hubs.

CVS is not a company that competes on merits. They rely on their monopoly power to squash competition. When that fails, they rewrite the rules or terrorize anyone challenging the status quo. Whether that’s small businesses, independent pharmacies, digital hubs, or the Tennessee State legislature, the result is always the same: higher costs and less access for patients.

This repeated pattern of unfair competitive tactics are features of a system deliberately engineered to protect CVS’s market power. They tilt the playing field in their own favor while independent pharmacies and struggling patients pay the price–confirmed by a recent Tennessee audit that found CVS Caremark reimbursed its own pharmacies at higher rates than independent ones. 

By passing the FairRx Act, the legislature fittingly took a page out of CVS’ own playbook: they rewrote the rules. Signing the bill into law gives Gov. Bill Lee an opportunity to validate the legislature’s  unambiguous message: in Tennessee, insider politics, dark money, deceptive advertising and intimidation won’t fly. In the true spirit of the Volunteer State, the governor must make clear that patients come before profits and constituents come before corporate interests.

Independent pharmacies deserve a fair shot. Patients struggling to afford life-saving prescriptions deserve a system that works for them, not against them. The legislators driving this legislation have shown great courage refusing to cave to CVS’s pressure campaign. Now it’s time to finish the job and sign  the FairRx Act.