From Gene Ransom, Chairman, Physician Research Institute:
The future of healthcare is not about restricting options. It is about expanding access. States that recognize this principle will be best positioned to improve outcomes, enhance patient satisfaction, and create a more patient-centered prescription drug delivery system.
As I review the legislative activity taking place across the country, I see a clear trend emerging. The debate is no longer simply about prescription drugs. It is about who controls patient access to those drugs.
During the 2026 legislative sessions, lawmakers in states including Arizona, Georgia, Oklahoma, Hawaii, Louisiana, Florida, and Maryland considered proposals affecting physician dispensing, pharmacy networks, PBM oversight, reimbursement, and mail-order pharmacy services. While the details varied, the central question remained the same: should patients and their practitioners determine how medications are delivered, or should those decisions increasingly be made by insurers and pharmacy benefit managers?
At the Physician Research Institute, we believe the answer should begin and end with what works best for patients.
The reality is that there is no single pharmacy delivery model that serves every patient. Some patients benefit most from a traditional community pharmacy. Others benefit from physician dispensing, where medication can be provided immediately at the point of care. Still others benefit from mail-order pharmacy, which has become one of the most effective tools for improving medication adherence, reducing transportation barriers, and ensuring patients receive maintenance medications consistently.
Unfortunately, many of the legislative proposals introduced this year focused less on improving patient access and more on controlling the channel through which medications are distributed. In Arizona, Georgia, and Oklahoma, policymakers debated proposals that would expand insurer-directed pharmacy networks and reduce flexibility for both patients and practitioners. Supporters framed these measures as cost-control initiatives, but opponents raised legitimate concerns about treatment delays, disruptions in care, and reduced patient choice.
As policymakers look toward 2027, I believe the conversation needs to shift.
The healthcare system should embrace both physician dispensing and mail-order pharmacy as complementary tools that improve access to care.
Physician dispensing offers clear advantages. Patients can begin treatment immediately following a visit. Medication adherence improves when patients leave the office with therapy already in hand. Rural communities, workers’ compensation patients, and individuals facing transportation challenges often benefit significantly from practitioner dispensing programs. Most importantly, physician dispensing keeps medication management integrated with the clinical team directing the patient’s care.
At the same time, mail-order pharmacy has become an indispensable part of modern healthcare delivery.
For patients managing chronic conditions such as diabetes, hypertension, asthma, or cardiovascular disease, mail-order services offer convenience, reliability, and continuity. Home delivery reduces missed refills, eliminates unnecessary travel, and helps patients remain compliant with long-term treatment plans. As healthcare increasingly moves toward value-based care and outcome measurement, mail-order pharmacies will continue to play an important role in improving adherence and reducing avoidable complications.
The choice between physician dispensing and mail-order pharmacy is a false choice.
Patients benefit when both options are available.
What patients do not benefit from are policies that force them into a single pharmacy channel regardless of their circumstances. Whether that channel is a PBM-owned mail-order pharmacy, a restricted network pharmacy, or another mandated distribution model, reduced flexibility almost always results in lower patient satisfaction and diminished continuity of care.
Maryland’s experience reflects the broader national trend. While discussions in Annapolis have focused on prescription drug affordability, PBM oversight, reimbursement models, and pharmacy access, policymakers have also shown increasing interest in limiting inappropriate pharmacy steering and preserving patient choice. Similar conversations are occurring across the country as states examine the growing influence of vertically integrated PBMs and affiliated pharmacy networks.
Looking ahead, I expect several trends to continue. States will likely pursue greater PBM transparency, increased scrutiny of pharmacy ownership structures, expanded protections against inappropriate pharmacy steering, and additional efforts to modernize physician dispensing laws. At the same time, mail-order pharmacy will continue to expand as patients increasingly seek convenience and healthcare systems focus on improving medication adherence.
From my perspective as Chairman of the Physician Research Institute, the best public policy approach is straightforward.
Protect patient choice.
Support physician dispensing.
Embrace mail-order pharmacy.
Encourage innovation.
And most importantly, ensure that patients can obtain medications through the channel that best meets their clinical needs.
The future of healthcare is not about restricting options. It is about expanding access. States that recognize this principle will be best positioned to improve outcomes, enhance patient satisfaction, and create a more patient-centered prescription drug delivery system.
Gene Ransom
Chairman
Physician Research Institute
