A new law designed to protect rural independent pharmacies isn’t being enforced, pharmacists say

ROCKY FORD, Colo.  — A new state law to help keep rural pharmacies afloat went into effect on the first day of 2026, but pharmacists say they are not yet seeing the benefits they were promised. 

“It certainly hasn’t had the effect that it was intended … yet,” said Ky Davis, pharmacist and owner of Harris Pharmacy in Rocky Ford, a town of fewer than 4,000 people.

The new law, which took effect Jan. 1, requires pharmacy benefit managers (PBMs) — the middlemen between drug makers and pharmacies — to reimburse rural independent pharmacies no less than the average national cost of the drug, plus a dispensing fee. It addresses long-standing concerns of rural independent pharmacies being underpaid by PBMs. 

“We continue to see pharmacy shortages increase and put more strain on the system, and this kind of bill is intended to help alleviate that,” Davis said. “But no action has been taken yet to enforce it.” 

The Colorado Division of Insurance, responsible for enforcing the law, has not yet issued formal guidance on which pharmacies are considered rural independents under the new law. The agency’s spokesperson, Genna Morton, said they are finalizing it in the coming weeks.

“We encourage pharmacies to let us know through our complaint portal if they believe they aren't being reimbursed appropriately,” Morton said. 

But some pharmacists argue that requiring pharmacies to file individual complaints for each disputed reimbursement adds to the burden on already overstretched pharmacies.

For now, the law meant to give rural independent pharmacies a lifeline only exists on paper. Since the law took effect, Harris Pharmacy should have earned roughly an additional $3,700 on 500 prescriptions from Jan. 1 to Jan. 16, but PBMs paid the pharmacy only half of what they are supposed to, according to Davis’ database. 

Only one PBM, Elevance Health, Inc., is paying the required rate, but the three largest PBMs that cover 80% of Harris Pharmacy’s claims aren’t complying, Davis said. 

Those are CVS Caremark, Express Scripts and Optum Rx, which have not changed their pharmacy reimbursement rates since the law took effect. A 2025 Federal Trade Commission report found that these three major PBMs hiked prices — sometimes by thousands of percent — on a wide range of lifesaving drugs, squeezing independent pharmacies.

"We look forward to reviewing the Colorado Department of Insurance's updated guidance governing the new law,” said Phil Blando, executive director of CVS Caremark. 

Tyler Mason, a spokesperson for Optum Rx, said pharmacies can contact its network and claims teams with questions to help resolve issues. Express Scripts did not respond for comment. 

Davis filed a complaint with the Colorado Division of Insurance about PBMs not complying with the law. He is still waiting for a response while they investigate his claim, he said. 

“We just like to be paid a fair amount all the time,” Davis said. “It's easier to run a business when you know what's going on and it's not pulling a slot machine and seeing what happens every time you do a claim.”

Davis considers himself fortunate that his family, which has operated the pharmacy since 1943, owns the building outright, so he does not have to pay rent.

“But other pharmacies have to pay rent, and oftentimes pretty high rent. So for them, it is the case of, like, stealing from their retirement fund to keep doors open,” Davis said.