It’s happening again. Legislators in Tennessee and Oklahoma are each introducing bills that, if passed, would have the same effects as Arkansas’s Act 624, a law that federal courts already blocked for interfering with veterans’ healthcare.
Earlier this week, Oklahoma introduced House Bill (HB) 4457, which would bar pharmacy benefit management companies from directly or indirectly owning any type of retail or mail-order pharmacy that sells prescription drugs in Oklahoma.
Also this week, Tennessee legislators introduced Senate Bill (SB) 2040, which, if passed, would make it illegal for pharmacy benefit management (PBM) companies to own, operate, provide services for, or even influence the many pharmacies they already own and operate for Tennesseans. This includes many mail-order pharmacies disabled veterans depend on for their prescription drugs.
Even though these rules would take effect on January 1, 2027, the bill would disrupt PBM-owned pharmacy operations almost immediately after passage, as PBMs must immediately begin selling their pharmacies in 2026. If they do not, their pharmacies risk losing their licenses to sell prescription drugs.
This isn’t just about corporate structure. It’s about veterans’ access to medications.
For more than 20 years, Express Scripts has served as the principal mail-order pharmacy provider for TRICARE. It operates pharmacy facilities as part of its integrated service model. If Tennessee and Oklahoma force divestiture, one of two things must happen: 1) Either Express Scripts shuts down its pharmacy operations in both states, eliminating a critical node in the TRICARE network; or 2) the Department of War is forced to reorganize its entire pharmacy program state-by-state. This will destroy the national coordination that makes TRICARE cost-effective.
If politicians in Tennessee and Oklahoma want to show they truly honor those who served, they should learn from last year’s mistakes in Arkansas and protect TRICARE access instead of dismantling it.
What’s at Stake for Tennessee and Oklahoma Veterans
Roughly 440,000 veterans live in Tennessee, and more than 275,000 veterans live in Oklahoma. These Veterans using TRICARE have more health challenges than nearly any other group in the U.S. Many are handicapped physically and mentally from their service. Extreme stress from enduring conditions in Iraq, Afghanistan, and other theaters of war has made veterans more susceptible to PTSD, depression, and anxiety disorders.
Veterans in both states’ rural communities face particularly tough challenges. Over 4.4 million American veterans live in rural America, facing barriers including long travel distances, shortage of healthcare workers, and limited broadband access. Taking away veterans’ mail-order options and isolating them in pharmacy deserts is cruel, especially considering so many gave so much for our country already.
What Tennessee and Oklahoma Should Do Instead
If legislators in these states genuinely want to protect consumers and pharmacies without harming veterans, they have options:
Pursue targeted transparency. Judge Miller noted that Arkansas already had laws addressing discriminatory reimbursement and unfair network exclusions. State legislators in Tennessee and Oklahoma can strengthen transparency requirements, audit rights for plan sponsors, and reporting obligations without forcing divestiture or imposing pricing mandates that conflict with federal contracts.
Invest in pharmacy access. Instead of dismantling the PBM-pharmacy integration that makes mail-order possible, these legislators could fund programs supporting pharmacies in underserved areas.
Focus on existing regulations. Between Tennessee and Oklahoma, PBMs have been increasingly regulated through restricted pricing, new reimbursement rules, and greater business transparency – all without forcing divestiture or disrupting federal programs. Tennessee’s SB2040 and Oklahoma’s HB4457 go far beyond these measured regulations, crossing constitutional lines that courts have already drawn. These constitutional lines protect our veterans, and once crossed, it is our veteran population that carries the cost.
Support Our Veterans
Ever since World War II, the private sector fulfills an outsized role in supporting national priorities. Developing the infrastructure used in healthcare delivery—along with the talent, access, and placement—is instrumental, as the military healthcare system continues to serve 9.5 million beneficiaries worldwide.
Politicians in Oklahoma and Tennessee have a choice: learn from Arkansas’s mistake or repeat it at our veterans’ expense. Like Arkansas Act 624, the Federal courts will likely strike down SB2040 and HB4457, but not before creating months of uncertainty for military families who depend on TRICARE pharmacy access.
As veterans ourselves, people are always quick to thank us for our service. But now it’s time to not just thank veterans, but to act on their behalf. We need to protect veteran access to prescriptions. We need to protect TRICARE. We need to protect veterans’ access to the pharmacy benefits they earned through their service. And recognize that some things, like the healthcare of those who defended our nation, are too important to sacrifice for politics.
