Mary Klein, Pharm.D., will serve as AVP of Strategic Initiatives and Practice Innovation. She brings a wealth of experience in pharmacy practice and is a well-respected expert in primary care and rural health. Mary is a past president of the Association and has served TPA for more than 15 years as a volunteer leader. Her tireless work in pharmacy advocacy across multiple organizations includes her current role as Speaker of the House for the American Pharmacists Association.

In addition to her part-time role at TPA, Mary will continue to educate future pharmacists as a faculty member at the Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy. Her deep expertise in patient access to rural health services and her heart for the profession make her a powerhouse addition to the TPA team!

Haley McKeefer, Pharm.D., joins TPA as Director of Strategic Partnerships. She brings deep expertise in health policy and pharmacy practice to TPA, where she will lead collaborations within the pharmacy and health care ecosystem and drive innovative care delivery models across the state. She has served as Chair of TPA’s Academy of Student Pharmacists and as a Texas Pharmacy Foundation Trustee and is thrilled to come back home to TPA.

Haley earned her pharmacy degree from the UNT Health College of Pharmacy and completed a two-year Health Policy and Communications fellowship with the National Pharmaceutical Council and the Rutgers Pharmaceutical Industry Fellowship Program. Her experience in studying the impact of policy on patient access to pharmacy services and her innovative vision for the profession make her a valuable asset to the Association!

Texas pharmacists today applauded passage of landmark reforms to help rein in some of the abusive business practices long used by unregulated pharmacy benefit managers (PBMs) — middlemen in the drug supply chain that are widely blamed for driving up costs for patients and forcing many local pharmacies to close their doors.

The reforms are contained in H.R. 7148, funding legislation passed by Congress and signed into law by President Trump on Tuesday. The measure will increase transparency, preserve Medicare beneficiaries’ access to pharmacies by creating a new “essential pharmacy” designation, and begin to address costs by reforming some of the business practices of PBMs.

"The anti-competitive, anti-patient tactics employed by PBMs have threatened the ability of many pharmacists to deliver quality health care to our communities," said Texas Pharmacy Association President Jason Davis. "This federal legislation will help correct inequities in the system with a healthy dose of transparency and fairness, which can ultimately protect access to the neighborhood pharmacies patients trust.

“While these reforms affect patients in Medicare,” he added, “we look forward to working with the Texas Legislature to enact further meaningful reforms at the state level to address similar concerns for all patients.”

The legislation will also benefit rural Texans through an “essential pharmacy” designation, helping to ensure rural Texans have access to a pharmacy within 10 miles that is not owned or controlled by a PBM.

“Pharmacists are the most accessible health care providers – and often the only health care providers – especially in rural areas. We are the hub, and we do a lot for the community,” said Crystal McEntire, a pharmacist who owns two independent pharmacies in the Texas Panhandle. “Frontline health care in rural pharmacies is saving lives, saving ER resources and keeping care close to home."

The legislation includes the following key provisions:

• Increases transparency for PBM contracts in Medicare. PBMs will no longer profit at the expense of patients when a PBM steers a patient to a higher priced drug.
• Protects patient access to local, neighborhood pharmacies by establishing when a pharmacy is considered “essential.” PBMs and Medicare Part D prescription drug plans will be required to contract with any pharmacy that agrees to their standard, contract terms. This is aimed at reining in PBMs that often steer patients to their affiliated or favored pharmacies.
• Provides the Centers for Medicare & Medicaid Services (CMS) authority to regulate contracts between PBMs and Medicare Part D prescription drug plans. This will help address abusive contract provisions that often undermine neighborhood pharmacies, ultimately hurting patients.
• Shines a light on PBM payment practices by allowing CMS to monitor the way pharmacies are paid by PBMs. This provision will also allow CMS to track which pharmacies are included or excluded from PBM networks, injecting much-needed transparency into the system.

The reforms were contained in appropriations legislation that passed the House by a 217–214 vote and previously passed the Senate by 71-29.

PBMs manage prescription drug benefits for insurers, employers and government payers. They have been widely criticized for abusing that power to increase their profits at the expense of patients and neighborhood pharmacies. Because of PBMs’ questionable practices, scores of neighborhood pharmacies have been forced out of business. At least one Texas pharmacy has closed every week for the past two years.

The Texas Pharmacy Association is taking action and raising concerns about a proposed rule relating to access to network pharmacies under the Texas Medicaid program. Today, the Association submitted informal comments in a letter to Texas Health and Human Services Executive Commissioner Cecile Erwin Young expressing substantial concern about the rule’s potential impact.

“The proposal, as drafted, could inadvertently restrict [patient] access and lead to higher long-term costs of care,” TPA wrote. “We strongly recommend a comprehensive discussion before the rule advances.”

The draft rule reduces the expectations placed on managed care organizations (MCOs) at a time when HHSC’s own reports reflect worsening network compliance and rising total cost of care. TPA asserted that MCOs should be increasing their efforts to enroll Texas pharmacies to improve their members’ access to health care in every county, and maintain fidelity to their contractual expectations.

Potential Impact on Pharmacies

“We are concerned that the proposed changes will result in more stores closing or, at minimum, fewer pharmacies serving Medicaid customers,” TPA wrote, noting that Medicaid patients “may face substantial delays in obtaining medications and basic health care support, running counter to both state and national conversations about strengthening rural care infrastructure.”

TPA also explained that pharmacy benefit managers’ inadequate reimbursement has resulted in fewer pharmacies and is the root cause of health plans' inability to comply with the state’s network adequacy standards. “Loosening the network adequacy standards fails to address the root cause of the problem and, instead, rewards the entities responsible for the problem,” the letter says.

TPA’s requests include:

• For HHSC to meet with TPA and other Texas pharmacy organizations to communicate the intent of the project and share the data supporting the proposed changes
• Clear and publicly available oversight documentation
• Regular reporting on MCO corrective action plans
• Assurance that the proposed rule changes do not inadvertently reward poor performance or disadvantage Texans, via results of data analytics and geomapping
• Consideration for pharmacy representation on the HHSC Managed Care Advisory Committee.

Legislative Support

Additionally, TPA is securing meetings with state legislators and other elected officials to share these concerns, especially since the proposed rule appears to thwart the legislative intent of SB 760, passed by the 84th Legislature (2015), meant to strengthen network adequacy requirements and ensure enforcement.

Questionable Mid-Contract Renegotiations Come Weeks After Effective Date of New Law Poised to Rein in Anti-Competitive, Anti-Consumer Practices

Express Scripts, Inc., the nation’s largest pharmacy benefit manager (PBM), is forcing many Texas pharmacies into mid-contract modifications—a move that could drive more pharmacy closures and limit more patients to mail-order transactions for their medicines. The move comes weeks after a new law took effect that is designed to stop anti-consumer and anti-competitive tactics that have already driven some pharmacies in Texas to close.

Express Scripts, which manages prescription drug benefits for insurers, employers and government payers, is forcing unilateral contract amendments on many Texas pharmacies. In some cases, Express Scripts is denying pharmacies enrollment in the Express Scripts network altogether. For pharmacies who remain in network, Express Scripts offers reimbursement for pharmacy services that compensates them less than cost of the medications they purchase and dispense.

Express Scripts Contract Modifications Provide Pharmacies with Impossible Choices

Express Scripts’ contract modifications are far reaching and could impact patients statewide, as well as current and retired state employees, veteran beneficiaries, public school teachers, and public university system employees. According to the Texas Pharmacy Association, Express Scripts has been offering some pharmacies “all or nothing” contracts for its prescription drug management services – which is an apparent violation of provisions in Senate Bill 1236. The Legislature unanimously passed the bill this year and Governor Greg Abbott signed it into law in May. The key consumer-protection provisions of the bill took effect September 1, 2025.

“Senate Bill 1236 is aimed at helping address the anti-competitive, anti-consumer practices of middlemen in the pharmaceutical supply chain known as pharmacy benefit managers,” said Texas Pharmacy Association CEO RoxAnn Dominguez. “That’s why we are concerned with what some might see as an end-run around this legislation with an 11th-hour move to change contracts with local pharmacies.”

Dominguez said this may reduce the number of independent pharmacies in PBM networks so that patients are forced to use mail order pharmacies that the PBMs own or control.

“To expect a pharmacy to earn medication reimbursement rates that are less than what they pay for the prescriptions is a brazen attempt to drive a community pharmacy – essentially a competitor to the PBM’s own pharmacies – out of business,” Dominguez said. “It’s unfair, it’s wrong, and it violates the spirit and in some cases the letter of Senate Bill 1236. This move could drive more pharmacies to close and could force some patients into PBM-controlled mail-order-only transactions for their medicines.”

PBMs have outsized influence over patients’ access to and out-of-pocket costs for prescription medicines. The country’s top three PBMs control the cost of the overwhelming majority of America’s filled prescriptions. In Texas, PBMs set reimbursement rates for virtually all pharmacies that accept insurance reimbursement. PBMs use this market power to direct patients to pharmacies they own or control, and they create obstacles to competition for independent and chain pharmacies alike. Express Scripts is the largest of the “big three” PBMs, handling 30% of all prescription drug claims in 2024.

PBMs’ outsized role in the marketplace and the unsustainable terms they impose on pharmacies create an impossible choice for these small businesses: accept a contract that very likely creates a net loss for the pharmacies or lose critical access to a large portion of the local patient population. Pharmacies cannot survive without market access and market access is controlled and abused by a handful of powerful PBMs. Senate Bill  1236 helps to address this problem, and Express Scripts’ recent actions serve as a clear reminder of why such laws are critical to protecting independent pharmacies and simple fairness.

SB 1236 Works to Prevent PBM Practices that Drive Independent Pharmacies Out of Business

PBMs have been widely criticized nationally for abusing their power and for their vertical integration, which is resulting in the gradual elimination of independent and competitive chain pharmacies and the reduction of consumer choice and access.  Scores of neighborhood pharmacies have been forced out of business, with at least one Texas pharmacy closing every week for the past two years. Urban and rural communities alike are being affected by pharmacy closures. From January 2023 through January 2025, Harris and Dallas counties topped the list with the most net pharmacy closures, at 79 and 30, respectively. This was followed by Fort Bend County with 18 net pharmacy closures, Hidalgo County with 15 and Tarrant County with nine.

These closures threaten pharmacy access for growing numbers of Texans, especially in low-income urban and rural areas. Some 4.3 million Texans now live in a pharmacy desert. And nearly 2 million Texans rely on a single pharmacy whose closure would create a pharmacy desert, further undermining access to care.

“Pharmacies are often the first and sometimes the only health care touchpoint for many Texans,” Dominguez said. “But PBMs’ abusive tactics threaten our ability to deliver quality care to our communities. We can’t let these health care lifelines disappear.”

What Is at Stake Under SB 1236

Senate Bill 1236 was written to protect patients and local pharmacies from the abusive business practices of powerful PBMs. The law requires fair and transparent contracts and prohibits PBMs from imposing a unilateral “adverse material change” to an existing contract, such as cutting reimbursement rates or changing key administrative terms without a pharmacy’s express agreement. Now, PBMs must notify pharmacies of their rights to reject such changes.

In other words, Texas lawmakers have made it clear: PBMs cannot change the rules midgame to the detriment of these small businesses and the communities they serve. Senate Bill 1236 is designed to restore balance and accountability in a system that has long tilted toward corporate middlemen.

Now, as Express Scripts pushes through last-minute contract modifications, it raises serious questions about whether these actions violate the spirit or even the letter of this new law. Texans deserve to know whether the state’s protections are being enforced and whether independent pharmacies can survive to continue serving their communities.

Pharmacy Inclusion as Primary Point for Health Care Mirrors Administration Goals as Advocated by Dr. Mehmet Oz, CMS Administrator

Texas’ pharmacies are poised to play a critical role in the state’s Rural Health Transformation Program – a new initiative that promises states a portion of $50 billion in federal funding to transform rural health care by building sustainable systems that enhance patient care.

Noting this vital role, the Texas Pharmacy Association (TPA) has proposed that rural pharmacies be included in the state’s funding application to the Centers for Medicare & Medicaid Services (CMS). A funding decision from CMS is expected by the end of the year.

“Pharmacies are the most accessible health care point in rural and underserved communities throughout our state,” said Ben McNabb, an Eastland pharmacist and member of the TPA Board of Directors. “Through chronic disease management, patient education and medication reconciliation, we’re helping prevent costly hospital visits and keeping Texans healthier.”

Pharmacists, technicians, and other pharmacy staff are stepping up to become certified as community health workers. This move, coupled with the pharmacists’ front-line presence in communities statewide, positions Texas rural pharmacies to help patients navigate the health care ecosystem and receive the best support for their conditions.

Pharmacists and community health workers are already helping Texans prevent and manage chronic conditions, support behavioral health needs such as suicide and fentanyl awareness, and collaborate with other health care providers to strengthen the state’s rural health care safety net.

“We’re the ones who notice when someone’s voice sounds different, when a refill is missed or when a caregiver sounds exhausted,” said Brandi Chane, nurse, certified pharmacy technician, and pharmacy owner in Weatherford. “It’s those moments – the phone calls, the check-ins – that prevent unnecessary hospital visits. A call center can’t do what we do. Mail order definitely can’t do that. But a trusted pharmacist or community health worker, embedded in the community, can.”

Texas boasts the largest rural population in the nation, making the Rural Health Transformation Program funding especially vital. Approximately 12.3% of Texas’ 5,120 community pharmacies are located across 200 rural counties with populations under 68,000.

Further, Texas is seeing an alarming number of pharmacy closures, right now at one per week. TPA says the situation will be exacerbated by new, untenable contracts being pushed by Express Scripts, the pharmacy benefit manager that covers state employees, teachers and more. That contract will push many state employees and teachers into mail order pharmacy only and could lead to more pharmacy closures and pharmacy deserts.

Therefore, the funding from the federal program is a lifeline for Texas pharmacists, their patients and families, and the local communities these pharmacies serve.

In recent testimony to the Texas Health and Human Services Commission (HHSC), McNabb said, “With funding through the Rural Health Transformation Program, Texas pharmacies can be the front door to patient care in many rural areas, helping fill critical gaps in the health care system and when the nearest hospital can be hours away. Rural pharmacists are already providing community health interventions that prevent 911 calls, emergency visits and human suffering.”

Crystal McEntire, who owns Panhandle pharmacies in Shamrock and Wheeler, agreed, adding, “Rural pharmacies like mine can safely handle basic front-line health care needs like removing stitches so a patient doesn’t have to drive many miles to an ER and pay hundreds of dollars. This is precisely what leaders like Dr. Mehmet Oz at CMS have been highlighting: expanding front-line health care access in rural communities so neighbors can stay closer to home for routine, non-emergency care.”

According to HHSC, $50 billion will be distributed to all states with approved Rural Health Transformation Program applications between fiscal years 2026 and 2030. Of that, $10 billion will be distributed each fiscal year, and states may spend funds for up to two years after they are awarded.

While the amount of federal funding Texas might receive if its application is approved is unknown, the TPA says its members are prepared to support the state’s program.

“Integrating pharmacists into the Rural Health Transformation Program framework could lead to more preventive care for rural patients, which could reduce unnecessary emergency room visits and hospitalizations,” concluded Jason Davis, TPA President and a pharmacist in Boerne. “Texas pharmacists are poised to help create a patient-centered health care system for all rural Texans.”

Parker's long and distinguished pharmacy career began in high school when he worked at Dougherty's Pharmacies in Dallas. He received his pharmacy degree from The University of Texas at Austin College of Pharmacy in 1954 and was a member of TPA since 1959. After serving in the U.S. Army, he returned to Austin to accept a position as Director of The University of Texas Pharmacy Extension Service and Assistant to Pharmacy Dean Henry Burlage.

From 1964 to 1990, he served as executive director of the Texas Pharmacy Association, and he received TPA’s Distinguished Service Award in 1979. He remained on staff as President and CEO of the Texas Pharmacy Foundation (TPF) until his retirement at the end of 2002. He educated and inspired the next generation of pharmacists as a clinical assistant professor at UT Austin, where he taught health care administration, pharmacy law, and contemporary pharmacy issues.

During his tenure at TPA, the Association matured and became a nationally respected organization, helping prepare national leaders of the American Pharmacists Association (APhA) and National Community Pharmacists Association. His many accomplishments included transitioning the Association’s membership from pharmacies to individual pharmacists. He also helped establish the existing system of local affiliates across the state, led the construction of TPA’s former headquarters in Austin, and co-founded the Texas Pharmacy Congress to facilitate collaboration among pharmacy stakeholders. Under his leadership, TPA organized a political action committee and effective lobbying program, strengthening relations with the Texas Legislature, U.S. Congress, and state agencies.

Parker was very active in a number of local, state, national and international professional organizations, including being elected Honorary President of the American Pharmacists Association. Luther’s wife, Mary Ann, actively supported him in his work by serving as president of local, state and national auxiliaries; through regular attendance at local, TPA and APhA meetings; and by raising funds for TPA and TPF. His legacy lives on through TPF’s Luther and Mary Ann Parker Scholarship, established in 2007.

Beyond his role as a legendary pharmacy leader, Parker shared his talent and dedication with the broader association community. A Certified Association Executive, he served as chair of the Texas Society of Association Executives from 1986 to 1987 and was named Distinguished Executive of the Year; he also served as vice chair of the American Society of Association Executives. In his local Austin community, Parker was active in many organizations including the Rotary Club and University Presbyterian Church.

A service celebrating his life will be held Saturday, Oct. 25, at 2 p.m. at University Presbyterian Church in Austin.

Texas pharmacists applaud Governor Greg Abbott for signing into law yesterday legislation to help protect Texas patients, pharmacies and employers from some of the anti-competitive, anti-consumer practices of middlemen in the pharmaceutical supply chain known as pharmacy benefit managers (PBMs).

Senate Bill 1236 by Sen. Bryan Hughes (R-Mineola) will help address abusive business practices of pharmacy benefit managers by requiring contract fairness and transparency, ensuring compliance with existing PBM laws, and prohibiting unfair fees. The measure was sponsored in the Texas House of Representatives by Rep. Cole Hefner (R-Mount Pleasant).

“The PBMs set the reimbursements for our local pharmacies, which are struggling to stay open,” Hughes said. “They also determine the prices for their own pharmacies. Senate Bill 1236 continues the Legislature’s efforts to make sure that anti-competitive behavior by someone with a lot of bargaining power, that’s been granted to them by the government, is not weaponized in the market.”

Texas Pharmacy Association CEO RoxAnn Dominguez praised Texas elected officials for their support of PBM reform this session.

“We are incredibly grateful to Governor Abbott for making SB 1236 the law in Texas, and to Sen. Hughes and Rep. Hefner for their hard work and dedication to Texas patients and pharmacists,” Dominguez said. “We look forward now to working with the Texas Department of Insurance and the Attorney General’s Office to implement SB 1236 for the betterment of patient care.”

PBMs manage prescription drug benefits for insurers, employers and government payers. They have been widely criticized for abusing that power to increase their profits at the expense of patients and neighborhood pharmacies. Because of PBMs’ questionable practices, scores of neighborhood pharmacies have been forced out of business. At least one Texas pharmacy has closed every week for the past two years.

TPA President Jobby John, a Lakeway pharmacist, said PBMs’ “anti-competitive tactics have threatened our ability to deliver quality healthcare to our communities. SB 1236 will go a long way toward correcting inequities in the system and ensuring transparency and fairness, which will help protect the neighborhood pharmacies that patients trust.”

SB 1236 received unanimous support in both the Texas Senate and Texas House. The bill generated powerful commentary from legislative leaders including from state Sen. Lois Kolkhorst, chair of the state Senate Committee on Health and Human Services.

During a Senate hearing on SB 1236, Kolkhorst noted that the top three PBMs control 80 percent of the drug supply market and questioned, “Who in America thinks that’s a good idea?” noting that “the losers are the pharmacists which are sometimes the only people that people in underserved areas get a chance to interact [with]. . . but the other loser is the patient.”

AUSTIN—Texas lawmakers have given unanimous approval and final passage to key legislation supported by Texas pharmacists that will help protect patients, pharmacies and employers from the anti-competitive, anti-consumer practices of middlemen in the pharmaceutical supply chain who are driving up prescription drug costs and forcing scores of neighborhood pharmacies out of business. At least one Texas pharmacy has closed every week for the past two years.

Senate Bill 1236 by Sen. Bryan Hughes (R-Mineola) will help protect patients and pharmacists from the abusive practices of pharmacy benefit managers (PBMs) by requiring contract fairness and transparency, ensuring compliance with existing PBM laws, and prohibiting unfair fees. The measure was sponsored in the Texas House of Representatives by Rep. Cole Hefner (R-Mount Pleasant).

PBMs, which manage the lists of prescription drugs covered by public and private health insurers, have been widely criticized in Texas and across the country for using a flawed system to profit unfairly at the expense of consumers, employee health plans and neighborhood pharmacies – all while driving business to pharmacies the PBMs own or control. The result has been increased prescription drug costs for patients and the forced closure of neighborhood pharmacies, which means the loss of a critical health resource, especially in rural and underserved communities.

“As pharmacists, our priority is patient care, but PBMs’ anti-competitive tactics have threatened our ability to deliver quality healthcare to our communities,” said Jobby John, President of the Texas Pharmacy Association (TPA) and a Lakeway pharmacist. “SB 1236 will go a long way toward correcting inequities in the system and ensuring transparency and fairness, which will help protect the neighborhood pharmacies that Texans trust.”

SB 1236 passed the Texas Senate in April with a vote of 31-0 and received unanimous support Tuesday in a vote in the Texas House of Representatives. The measure now heads to Texas Governor Greg Abbott.

“We are incredibly grateful to Sen. Hughes and Rep. Hefner for their hard work and dedication to Texas patients and pharmacists,” said RoxAnn Dominguez, TPA CEO. “We look forward to continuing to work with these lawmakers, other members of the Legislature, and Texas leadership to continue to support pro-patient legislation such as SB 1236.”

Currently, the nation’s largest PBMs control the cost of the overwhelming majority of America’s filled prescriptions, as well as significant chunks of the pharmaceutical supply chain, including the country’s largest retail pharmacy chains.

A series of recent government and private sector reports illustrates how the abuses PBMs heap on the drug distribution system have left Americans scrambling to pay for their prescription medications and forced many pharmacies to shutter their stores.

A January 2025 Federal Trade Commission (FTC) report found that the three largest PBMs “marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent.” These included “critical drugs used to treat serious diseases and conditions, including cancer, HIV, multiple sclerosis, and pulmonary hypertension,” according to the FTC report. “Additionally, the Big 3 PBMs reimbursed their affiliated pharmacies at a higher rate than unaffiliated pharmacies on nearly every specialty generic drug examined,” the report stated.[1]

In a July 2024 report, the FTC noted the three largest PBMs “wield enormous power and influence over patients’ access to drugs and the prices they pay. This can have dire consequences for Americans, with nearly three in ten surveyed Americans reporting rationing or even skipping doses of their prescribed medicines due to high costs.” Noting the impact of PBMs on independent pharmacy closures, the report stated: “Closures of local pharmacies affect not only small business owners and their employees, but also their patients. In some rural and medically underserved areas, local community pharmacies are the main healthcare option for Americans, who depend on them to get a flu shot, an EpiPen, or other lifesaving medicines.”[2]

Between January 3, 2023, and January 31, 2025, Texas experienced a net closure of at least one pharmacy every week, impacting rural and urban counties. This year’s closure list includes a San Angelo pharmacy whose owner blamed the PBMs’ low reimbursement rates for his store’s demise in January after 68 years of serving the community. “We really get pennies on the dollar,” said Bryan Abernathy, the pharmacy owner.

SB 1236 will help address these issues by:

• Protecting pharmacies from abusive PBM audit practices.
• Ensuring compliance with existing PBM laws.
• Prohibiting unilateral changes on key contractual provisions such as reimbursement rates during a PBM contract term.

Lawmakers Urged to End the Anti-Competitive, Anti-Consumer Practices of Pharmacy Benefit Managers

AUSTIN—More than 400 pharmacy professionals today urged Texas legislators to enact new laws to protect patients, pharmacies and employers from the anti-competitive, anti-consumer practices of middlemen in the pharmaceutical supply chain who are driving up prescription drug costs and forcing scores of neighborhood pharmacies out of business. At least one Texas pharmacy has closed every week for the past two years.

Rallying at the state Capitol, the pharmacy professionals also called for these middlemen – known as pharmacy benefit managers (PBMs) – to adhere to existing Texas laws requiring transparent contracts with independent pharmacies and fair compensation for their pharmacy services.

PBMs, which manage the lists of prescription drugs covered by public and private health insurers, have been widely criticized for using a flawed system to profit unfairly at the expense of consumers, employee health plans and neighborhood pharmacies – all while driving business to pharmacies the PBMs own or control. The result has been increased prescription drug costs for patients and the forced closure of neighborhood pharmacies, which means the loss of a critical health resource, especially in rural and underserved communities.

“As pharmacists, our priority is patient care, but PBMs’ anti-competitive tactics threaten our ability to deliver quality healthcare to our communities,” said Jobby John, President of the Texas Pharmacy Association (TPA) and a Lakeway pharmacist. “We’re not just small businesses; we’re critical health access points, often the first and sometimes the only healthcare touchpoint for many Texans. It’s imperative that legislators hold PBMs accountable, enforce transparency and protect the neighborhood pharmacies that Texans trust.”

TPA CEO RoxAnn Dominguez said PBMs drive up prices for patients at the pharmacy counter, increase costs for employers and undermine the financial health of local pharmacies. “PBMs decide which medicines patients can get and at what price,” Dominguez said. “They dictate lower reimbursement rates for neighborhood pharmacies but then often pay their own pharmacies more. And they decide what employers must pay for a key piece of their employees’ health premiums.”

The nation’s largest PBMs control the cost of the overwhelming majority of America’s filled prescriptions, as well as significant chunks of the pharmaceutical supply chain, including the country’s largest retail pharmacy chains. “The three largest PBMs control 80 percent of the market for prescription drugs,” said Ashley Garling, a pharmacist and TPA board member. “They use this market power to self-deal and direct patients to pharmacies they themselves own, and they throw up obstacles to competition for independent and chain pharmacies alike.”

A series of recent government and private sector reports illustrates how the abuses PBMs heap on the drug distribution system have left Americans scrambling to pay for their prescription medications and forced many pharmacies to shutter their stores.

A January 2025 Federal Trade Commission (FTC) report found that the three largest PBMs “marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent.” These included “critical drugs used to treat serious diseases and conditions, including cancer, HIV, multiple sclerosis, and pulmonary hypertension,” according to the FTC report. “Additionally, the Big 3 PBMs reimbursed their affiliated pharmacies at a higher rate than unaffiliated pharmacies on nearly every specialty generic drug examined,” the report stated.

In a July 2024 report, the FTC noted the three largest PBMs “wield enormous power and influence over patients’ access to drugs and the prices they pay. This can have dire consequences for Americans, with nearly three in ten surveyed Americans reporting rationing or even skipping doses of their prescribed medicines due to high costs.” Noting the impact of PBMs on independent pharmacy closures, the report stated: “Closures of local pharmacies affect not only small business owners and their employees, but also their patients. In some rural and medically underserved areas, local community pharmacies are the main healthcare option for Americans, who depend on them to get a flu shot, an EpiPen, or other lifesaving medicines.”

Between January 3, 2023, and January 31, 2025, Texas experienced a net closure of at least one pharmacy every week, impacting rural and urban counties. This year’s closure list includes a San Angelo pharmacy whose owner blamed the PBMs’ low reimbursement rates for his store’s demise in January after 68 years of serving the community. “We really get pennies on the dollar,” said Bryan Abernathy, the pharmacy owner.

“Year after year, we read the disturbing roll call of Texas pharmacies that had to close their doors because they were unable to survive amid PBMs’ anti-competitive tactics,” Dominguez said. “Our neighborhood pharmacies are small businesses that support their communities. Every time one closes, we lose jobs and tax dollars as well as a vital health resource.”

To address the anti-competitive tactics of PBMs, the Texas Pharmacy Association supports a package of bills now pending before the Legislature. They include:

• SB 1236 / HB 3317 – Protect patients and pharmacists from abusive PBM practices. Would require contract fairness and transparency, ensure compliance with existing PBM laws, and prohibit unfair fees.
  
• SB 1354 / HB 2978 – Prohibit below-cost reimbursement and require an appeal process for reimbursement errors.
  
• SB 1122 / HB 5102 – Ensure existing PBM reforms apply to all Texas residents and all PBMs in Texas.
  
• SB 493 – Ensure contracts between PBMs, health plans and pharmacies do not limit pharmacists’ ability to inform patients if their prescriptions would cost less when paying the cash price.
  
• HB 4533 – Require transparent reimbursement methodology for prescription drugs dispensed in Medicaid and state-funded programs.

Pharmacy benefit managers, or PBMs, serve as middlemen between health plans, patients, and pharmacies, determining not only which prescription drugs are covered but also at which pharmacies patients can fill their prescriptions. The three largest PBMs control approximately 80% of the nation’s drug claims. PBM practices are rife with self-dealing and threaten Texas pharmacies’ continued viability.

“PBMs are powerful organizations with the power to crush our small, independent pharmacies. When that happens, we see less competition and prices increase,” Hughes said. “An uneven playing field shortchanges pharmacists and creates barriers, denying Texans the medications they need.”

Hughes’ legislation would protect Texas pharmacies and the patients they serve by instituting audit protections, mandating contract fairness and transparency, ensuring compliance with existing PBM laws, and prohibiting unfair fees.

“This a watershed moment—one that can ensure a fairer, more competitive marketplace,” said TPA President Jobby John, Pharm.D. “While PBMs were created with the intention of reducing costs, we now see a system that has spiraled out of control, contributing to rising health care costs and creating an unsustainable cycle of negative reimbursements. This is a fight for fairness, transparency, and the survival of pharmacies across Texas.”

PBMs face mounting scrutiny nationwide for their lack of transparency and their role in driving up the cost of prescription drugs. In July 2024, the Federal Trade Commission (FTC) issued a scathing report finding that PBMs wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price. The FTC released a second interim staff report on January 14 focusing on PBMs’ influence over specialty generic drugs. Recent PBM reform legislation received broad, bipartisan support in Congress.

PBMs often use audits as a financial tool to aggressively claw back payments from pharmacies over minor clerical errors that do not impact patient care. They also use market power to force pharmacies to enter into “all or nothing” bundled contracts.

In 2021, the Texas Legislature took a bold stand against PBM overreach by passing two landmark laws—House Bill 1919 and House Bill 1763 to protect patients and pharmacies. Yet, PBMs continue to undermine these laws, creating deliberate confusion about their applicability to specific patients and contracts. Despite legislative efforts to ban exploitative fees, such as post-adjudication recoupments and transaction fees, PBMs have found new ways to squeeze pharmacies, demanding application and re-credentialing fees, sometimes before even allowing pharmacies to review contract terms. These predatory tactics threaten patient access, pharmacy viability, and the integrity of Texas' health care system.

Senate Bill 1236 would:

• Prohibit PBMs from recouping anything beyond a nominal dispensing fee as a result of an audit if a patient received the correct medication,
• Ensure any changes or modifications to contracts are provided to pharmacies with at least 90 days to review, and prohibit unilateral changes by the PBM without pharmacy consent,
• Require patient ID cards have unique identifier numbers for plans regulated by the Texas Department of Insurance and would require PBM contracts to indicate that the terms are subject to the Texas Insurance Code, increasing oversight clarity, and
• Prohibit certain fees that are unfair to community pharmacies.

In a significant win for Texas pharmacists and their patients, Texas Attorney General Ken Paxton issued a long-awaited opinion on Wednesday regarding two key pharmacy benefit manager (PBM) reform bills enacted in 2021 that are intended to curb abusive practices by PBMs. The attorney general's opinion indicates that these laws do, in fact, apply to PBMs serving ERISA plans normally outside the scope of Texas Department of Insurance (TDI) oversight.

Paxton indicated that neither bill would likely be pre-empted should they be challenged in court, which should lead to more rigorous regulation and enforcement against PBMs operating in Texas.

Why This Is Important

Both of the laws in question, House Bill 1763 and House Bill 1919, passed during the 87th Legislature in 2021 with overwhelming support. House Bill 1763 addresses several PBM practices relating to contracts with pharmacies. House Bill 1919 addresses PBM steering practices that push or require patients to use pharmacies affiliated with a PBM.

However, questions remained whether the laws applied broadly to PBMs, including those operating under ERISA self-insured plans, or whether the legislation narrowly applied only to fully insured insurance plans regulated by TDI. Since only around 15 percent of Texans receive health benefits through fully insured commercial plans, the result on this opinion broadens the application of the two laws.

The Texas Pharmacy Association thanks Sen. Charles Schwertner, one of the bills' authors, for requesting the attorney general's opinion. In August, TPA sent a letter to Attorney General Paxton outlining our position that both laws should apply broadly to PBMs operating in Texas, and rebutting the arguments made by lobbyists and attorneys for the PBMs and health plans urging pre-emption.

TPA is also grateful to Sen. Bryan Hughes, Rep. Cody Harris, and Rep. Tom Oliverson, each of whom authored or sponsored one of the laws in question.

The Fight Is Not Over!

There is still much work for pharmacy to do! As expected, business groups are already claiming that this opinion could “potentially increase costs for Texas businesses and disrupt employer-sponsored health benefits.” TPA is working to make sure legislators understand that this is false.

While HB 1763 and HB 1919 helped with many issues, reimbursement remains a challenge for pharmacists and will be a major focus of TPA's PBM reform efforts this session.

Throughout 2024, the Texas Pharmacy Association worked to achieve the four objectives outlined in its strategic plan—membership, advocacy, the profession, and association vitality—through a variety of activities and initiatives. TPA’s 2024 Annual Report highlights how each element was designed to help elevate the profession and advance the practice of pharmacy in Texas to care for patients. Read the report online or in the Winter 2025 issue of Texas Pharmacy magazine for more details.

Read TPA's 2024 Annual Report

The Texas Pharmacy Association has named RoxAnn Dominguez, Pharm.D. as its new Chief Executive Officer, effective September 1, 2024. The Association’s board of directors selected Dominguez following a nationwide search to help lead the organization as it seeks to continue to elevate the profession and advance the practice of pharmacy to care for patients.

“We are excited about RoxAnn Dominguez’s appointment as the new CEO of the Texas Pharmacy Association,” said TPA President Jobby John, Pharm.D. “With more than 20 years of experience in pharmacy, RoxAnn brings a rich background to TPA. Her expertise in market access, strategy, and business planning will provide us with valuable insights and help us with organizational growth.”

With a robust background in the pharmaceutical and health care sectors, Dominguez has held key roles in health plan and pharmacy benefit manager (PBM) operations, as well as in specialty and network contracts. Her strategic acumen was pivotal as vice president for a specialty pharmacy, where she managed the Pharmacy Services Administrative Organization (PSAO) and championed the interests of pharmacies in negotiations with PBMs and payers. Dominguez also made significant contributions as co-chair of the Texas Medicaid Drug Utilization Review (DUR) Committee, enhancing Medicaid drug utilization practices. Her career further expanded in her work with leading pharmaceutical manufacturers, where she continued to drive progress in the field.

“I am passionate and energized about the important work of TPA, and I look forward to using my pharmacy experience to advance our mission,” Dominguez said. “I am confident that my strategic vision, leadership capabilities, and dedication to excellence will benefit the Association and our members. My goal is to drive meaningful progress, advocate for our members, and contribute to the advancement of pharmacy.”

A native of El Paso, Dominguez earned her undergraduate degree from The University of Texas at Austin before pursuing her Doctor of Pharmacy (Pharm.D.) degree from Texas Tech University Health Sciences Center (TTUHSC). She furthered her expertise through a residency in psychopharmacology at UT Austin. Dominguez, based in Austin, balances her professional success with family life, raising her two young sons, aged 7 and 8.

Dominguez succeeds Debbie Garza, R.Ph., who has served as CEO since 2017. During her tenure, Garza helped TPA achieve significant legislative wins related to pharmacy benefit manager (PBM) reform and other issues important to Texas pharmacists. Her tireless efforts also increased the Association’s membership, strengthened its finances, and positioned TPA as the leading voice for Texas pharmacy.

“Debbie has been described as a 'force of nature'—someone who wills great things into existence through effort, determination, and talent,” said Jay Bueche, R.Ph., immediate past president of TPA. “Her impact on TPA will be felt for years, if not decades, to come.”

The CEO search committee—chaired by TPA Past President Mary Klein—included TPA Members Kevin Aloysius, Raj Chhadua, Lauren Clark, Carter High, Aimee Lusson, and Jesus Rios.

Texas student pharmacists competed in a number of events to earn bragging rights for their school during the 2024 TPA Conference & Expo in Allen, TX.

The team from the Texas Tech University HSC Hodge School of Pharmacy won the Student Pharmacist Self-Care Competition, a “Jeopardy”-style game testing students’ knowledge of OTC medications. For the first time, all nine Texas colleges/schools of pharmacy competed. Also new this year, alumni in the audience showed their school spirit to give their alma mater a chance to add 100 points to their final score.

Adam Campos (UT Austin), Hunter Adam (University of Houston) and Afsana Musharof (Texas Tech University) won first, second, and third place respectively at the Patient Counseling Competition.

During the President’s Celebration, The University of Texas at Austin College of Pharmacy was awarded the coveted TPA-Academy of Student Pharmacists (ASP) Cup, recognizing a year-round competition that focuses on advocacy, community outreach, and unifying pharmacy.

Hundreds of pharmacists, student pharmacists, and technicians from across the state gathered July 26–28 at the 2024 TPA Conference & Expo in Allen, TX, to meet face-to-face with their pharmacy peers. The message throughout the event was clear: Game on!

Educational sessions covered topics ranging from legislative advocacy and regulatory updates to artificial intelligence and pharmacogenomics. In addition to the opportunity to receive up to 14 hours of continuing education, attendees had the opportunity to hear from and meet Michael Hogue, executive vice president and CEO of the American Pharmacists Association, who provided an optimistic outlook on the state of pharmacy.

APhA CEO Michael Hogue, Texas Pharmacy Foundation (TPF) Chair-Elect May Woo, APhA President Alex Varkey, and TPF Chair Mary Klein.

Other highlights included legislative keynote remarks from State Senator Bryan Hughes and State Representative Candy Noble regarding their perspectives on the upcoming session, including issues affecting health care. Following their presentations and panel discussion, outgoing President Jay Bueche administered the oath of office to Jobby John, who was sworn in as the 2024–2025 President of the Texas Pharmacy Association.

Rep. Candy Noble and Sen. Bryan Hughes.

TPA’s Awards Dinner celebrated the best among us, honoring nine award winners and 21 Texas Pharmacy Foundation scholarship recipients. Congratulations to all of these distinguished Texas pharmacy professionals!

The expo hall afforded attendees the opportunity to meet with representatives from more than 50 vendors, to support TPA’s PharmPAC by purchasing a limited-edition mug, and to help fund the future of pharmacy at the Texas Pharmacy Foundation’s silent auction and raffle.

Mark your calendar to join us next year for the 2025 TPA Conference & Expo, July 18–20 at the Marriott Austin Downtown!

Tarrant County Pharmacy Association members.

TPA’s PharmPAC Luncheon, featuring State Representative Toni Rose (D-Dallas), was held July 26 during the 2024 TPA Conference & Expo.

Rose serves as vice chair of the House Human Services Committee and on the Select Committee on Health Care Reform, as well as on the Committees on Appropriations (vice chair of Article II Subcommittee), Calendars, and Redistricting. In 2023, Rose authored and fought for legislation that would have required Medicaid managed care organizations and their pharmacy benefit managers (PBMs) to reimburse pharmacies based on NADAC plus a professional dispensing fee.

Rose held the audience’s attention as she spoke candidly about working with other legislators of both parties and in both houses of the Legislature and took audience questions about how pharmacy professionals can best advocate for their profession and the patients they serve.

The Texas Pharmacy Association is pleased to announce the 2024 recipients of TPA's prestigious awards. These members will be recognized at our Awards Dinner on July 27 during the 2024 TPA Conference & Expo in Allen, TX. The awards recognize exceptional Texas pharmacy professionals who have contributed significantly to their profession. Each was nominated by one or more peers and selected by a committee of the TPA Association Affairs Council.

Congratulations to the following honorees:

• Bowl of Hygeia: Bruce McAnally, R.Ph.
• Pharmacist of the Year: Benjamin McNabb, Pharm.D.
• Distinguished Young Pharmacist: Andrew Wall, Pharm.D.
• Distinguished Student Pharmacist: Heather Howell
  
• Distinguished Pharmacy Technician: Theresa Day, CPhT, PhTR
  
• Distinguished Service Award: Amanda Stallings, Pharm.D.
• Excellence in Innovation: Carlos Irula, Pharm.D.
• Robert L. Hays Outstanding Consultant Pharmacist: Sylvia Perry, Pharm.D.

TPA President Jay Bueche (far right) listens as CEO Debbie Garza addresses pharmacist immunizations.

The Texas Pharmacy Association promoted the value of expanding Texas pharmacists’ authority to administer vaccinations and “test and treat” on May 21 at the Texas Conservative Caucus Research Institute (TCCRI) Healthcare Policy Summit in Austin. TPA CEO Debbie Garza participated in a panel discussion about retail health services, including pharmacists’ authority to administer vaccinations. TPA President Jay Bueche, representing H-E-B, was also on the panel alongside Senator Pete Flores, Representative Tom Oliverson, and subject matter experts from Walmart and Walgreens.

A second panel explored a variety of health care issues related to improving accessibility and affordability of care, including scope of practice for nurse practitioners, telehealth services, limiting facility fees, and reducing health insurance mandates.

TPA student pharmacist members from all across the state gathered in Austin on April 20 to attend the inaugural program of TPA’s Student Leadership Institute. Students had an opportunity to gain leadership skills and learn how to link those skills with advocacy to effectively elevate the profession and advance the practice both today and tomorrow.

Independent pharmacists and technicians from across Texas traveled to Washington, D.C. this week to participate in the National Community Pharmacists Association (NCPA) Congressional Pharmacy Fly-In.

TPA members had the opportunity to meet with members of Congress and their staff to advocate for pharmacy benefit manager (PBM) reform. PBM reform legislation that bans spread pricing and uses NADAC plus a professional dispensing fee in Medicaid and in Medicare requires reasonable and relevant reimbursement overwhelmingly passed the House of Representatives as well as the Senate committee of jurisdiction. The clock is ticking on an opportunity to get this legislation across the finish line. Congress needs to get it done.

Attendees also heard from notable speakers including Congressman Buddy Carter (R-GA), one of only two pharmacists in Congress and a powerful advocate for pro-patient, pro-pharmacy legislation.

Texas Pharmacy Association leaders attended the 2024 Texas Conservative Coalition Research Institute (TCCRI) Policy Forum on April 4 in Austin. TPA President Jay Bueche, President-Elect Jobby John, Vice President Jason Davis, Past President Carter High, Director Rannon Ching, Independent Pharmacy Academy (IPA) Chair-Elect Ben McNabb, Director Rannon Ching, Director Lauren Hayden, IPA Director Emeritus Bruce McAnally, and CEO Debbie Garza—along with Lobbyist Duane Galligher—represented TPA.

The event featured Texas Lieutenant Governor Dan Patrick and former Arkansas Governor Mike Huckabee, as well a panel of notable Texas legislators discussing the state's upcoming challenges.

TPA attendees had the opportunity to meet and greet legislators including House Public Health Committee Chair Stephanie Klick and Senator Pete Flores.

TPA member Alex Varkey was sworn in on March 25 as the 2024–2025 President of the American Pharmacists Association at the group’s annual meeting in Orlando. Varkey is director of pharmacy at Houston Methodist Hospital and received his Doctor of Pharmacy from the University of Houston. As a student, he served as national president of the APhA Academy of Student Pharmacists. TPA is proud to have Varkey and other distinguished members as national pharmacy leaders helping to advance the profession!

During the meeting, TPA Past President Mary Klein was elected the speaker-elect of the APhA House of Delegates. In her candidate speech, Klein donned a set of Minnie Mouse ears, a nod to the conference’s setting near Walt Disney World in Orlando. “I would contend that Minnie has big ears so that she can hear the dreams of those who come to meet her,” Klein said. “I have tried to be like Minnie meeting each of you this weekend and hearing what you have to say.” Klein, an associate professor at the Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy in Abilene, will serve as speaker-elect during the coming year, followed by a two-year term as Speaker from 2025 to 2027.

Texas Delegates Mary Klein, May Woo, Carol Reagan, Kevin Aloysius, Carter High, and Jay Bueche participated in the House of Delegates meeting during the APhA Annual Meeting and Exposition to debate and adopt policy proposals developed throughout the year. New policies developed included Artificial Intelligence Use in Pharmacy Practice and Cybersecurity in Pharmacy. Other APhA policies on the books were reviewed and edited to bring in line with current practice.

TPA's Public Policy Council meets.

Texas Pharmacy Association members met in Austin March 5–6 for the spring Leadership Retreat. The event began with meetings of TPA's three standing councils on Tuesday, where members gathered to make their voices heard and contribute to TPA's continued vitality.

Treasurer Lauren Corrales led the Financial Affairs Council meeting, where members reviewed the Association's financial statements, discussed endorsed vendors, reviewed the Association’s recently updated financial policies, received a membership update, and discussed additional revenue opportunities.

During lunch, council members heard a presentation from Andy Vasquez, formerly of the Texas Health and Human Services Commission (HHSC), and Laurie Vanhoose, a health care consultant with Treaty Oak Strategies, who presented a report titled, “Medicaid Pharmacy in Focus: Opportunities to Improve Texans’ Health and Access to Care.” The report, funded by the Episcopal Health Foundation and recently presented to HHSC’s Value-Based Payment and Quality Improvement Advisory Committee, was designed to identify and explore opportunities to leverage pharmacies to close gaps in care in the Medicaid program, with a specific focus on rural communities.

TPA’s Public Policy Council, chaired by Vice President Jason Davis, reviewed the current Texas political landscape, discussed possible interim charges for the Texas Legislature, encouraged members to engage in grassroots advocacy opportunities across the state, and had an extensive discussion to receive feedback from members about priorities for the 2025 legislative session. Finally, President-Elect Jobby John chaired the Association Affairs Council meeting, which planned the Association’s upcoming annual awards, discussed membership growth and engagement including a new digital membership campaign, and solicited ideas from members for upcoming educational programming.

Members of TPA's Independent Pharmacy Academy Board of Directors joined the TPA Board to discuss legislative and regulatory priorities.

On Wednesday, the TPA Board of Directors held its business meeting and was then joined by TPA's Independent Pharmacy Academy (IPA) Board of Directors to discuss the changing makeup of the Texas Legislature in light of Tuesday’s primary elections and to consider legislative and regulatory issues as we look ahead to next year’s legislative session. IPA Board members met afterward for their business meeting where they discussed opportunities to further unite and strengthen the voice of independent pharmacy in Texas for more robust and effective pharmacy advocacy.

Texas Pharmacy Association CEO Debbie Garza provided oral comments regarding two proposed rules during the Texas State Board of Pharmacy’s (TSBP) quarterly board meeting on February 6, 2024. The first proposed rule concerns delivery of prescriptions. Many of TPA’s requests, which included not limiting access to delivery of medications by having onerous delivery requirements on community pharmacies that deliver by employee or same-day courier service, were heard and the proposed rules were edited after lengthy discussion by the Board members. The edited proposed rules will be posted in the Texas Register for public comment and will then be up for final adoption at the May quarterly TSBP meeting.

The second proposed rule concerns non-sterile compounding. TPA confirmed that the rules did not apply to reconstitutes and commented on the short turnaround time provided for comments. Garza said TPA at this time supports most of the recommendations in the rules that were provided by the Compounding Advisory Group and noted that the language around beyond use dating provides more flexibility for pharmacists compounding non-sterile preparations.

The Texas Pharmacy Association hit the ground running in 2023 when the Texas Legislature convened in early January. TPA was ready with our strategy and legislative priorities defined by our volunteers and elected leadership—all focused on fulfilling our mission and vision on behalf of our members and the patients they serve. TPA's 2023 Annual Report highlights how the year marked progress toward our goals as we advanced important priorities and strengthened the profession. Read the report online or in the Winter 2024 issue of Texas Pharmacy magazine for more details.