Rural Texas Pharmacies Fight for Survival Against Powerful PBMs

Independent pharmacists in remote areas face dwindling profits and the threat of closure as Pharmacy Benefit Managers squeeze reimbursement rates.

Apr. 11, 2026 at 6:07pm

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A minimalist neon outline illustration depicting the silhouette of a rural Texas pharmacy building set against a starry night sky, conveying the essential role these small-town pharmacies play in their communities.The rural Texas pharmacy, a beacon of community healthcare, fights to survive against the powerful forces of PBMs.Wheeler Today

In the vast rural landscape of Texas, independent pharmacists are engaged in a battle for survival against powerful Pharmacy Benefit Managers (PBMs). Pharmacists like Crystal McEntire and Dana Tilton are forced to adopt creative strategies, like integrating their pharmacies with other businesses, just to keep their doors open. This crisis has left over 4.3 million Texans living in 'pharmacy deserts' with limited access to essential medications and community support.

Why it matters

The closure of these rural pharmacies would have a devastating impact on small communities, disrupting not just access to healthcare, but also the social fabric that these pharmacies help maintain. Pharmacists often serve as trusted confidants and advocates, going beyond their medical roles to support customers in myriad ways. Preserving these community hubs is crucial for the wellbeing of millions of Texans.

The details

PBMs, including giants like Optum Rx, CVS Caremark, and Express Scripts, are accused by independent pharmacists of squeezing them with unfair reimbursement rates, forcing them to sell medications at a loss. While the PBMs claim to be supporting rural pharmacies, the reality on the ground tells a different story, with these smaller pharmacies bearing the brunt of the low rates due to their lower revenue streams.

  • Over the past decade, Texas has witnessed a steady decline in pharmacies, with 60% of counties lacking a single pharmacy by 2023.
  • In 2026, the battle between independent pharmacists and powerful PBMs continues to unfold in rural Texas.

The players

Crystal McEntire

A rural Texas pharmacist who runs a cattle ranch by day and a pharmacy by night, using the ranch's revenue to keep her pharmacy afloat.

Dana Tilton

The owner of Dana's Pharmacy in the town of Spur, Texas, who has transformed her pharmacy into a jack-of-all-trades business offering everything from hair products to clothing and gifts alongside prescription medications.

RoxAnn Dominguez

The president of the Texas Pharmacy Association, who advocates for a flat-fee PBM model to bring more transparency and fairness to the system.

Charles Miller

An analyst from the nonpartisan think tank Texas 2036, who believes the issue lies in the very design of the PBM system and suggests that any overhaul should focus on the rules governing PBMs.

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What they’re saying

“Pharmacy is an industry that can kill you or cure you.”

— Crystal McEntire, Rural Texas Pharmacist

“We're doing our utmost to support independent rural pharmacies, and our reimbursement rates are fair and aligned with manufacturer pricing actions.”

— Spokesperson, PBM Company

What’s next

Lawmakers and policymakers are expected to continue examining the PBM system and explore potential solutions, such as the flat-fee model advocated by the Texas Pharmacy Association, to ensure the survival of rural pharmacies and preserve access to essential healthcare services in these communities.

The takeaway

The battle between independent rural pharmacists and powerful PBMs in Texas highlights the critical role these community hubs play in supporting the wellbeing of millions of Texans. Preserving these pharmacies is not just about access to medications, but also about maintaining the social fabric and trusted relationships that are the lifeblood of small towns across the state.