A piece of legislation passed by Texas lawmakers earlier this year has caused independent pharmacies across the state to close their doors. The new law dramatically cuts pharmacies profits by creating a ‘middleman’ in between Medicaid insurance and pharmacy reimbursements. "So far this year alone, I've taken at $8,000 negative margin." A two-way sword is how owner and pharmacist of medical center pharmacy, Luis Martinez describes how a new piece of legislation is impacting his pharmacy. "If I were to deny filling prescriptions for each patient who came in with a negative margin. I wouldn't have any patients left in the pharmacy." In March, the state of Texas has hired out of state manage care and pharmacy benefit managers, also known as PBMs. They act as the middleman between the Medicaid insurance and handling pharmacy claims. It saves the state money, but could cause pharmacies to close. "Whereas with the state of Texas I was getting somewhere around $6.35 for each prescription that I filled. These PBM's, as they come in, they've cut that down to $1.35." It especially affects the independent pharmacies along the border because we have a high Medicaid recipient population. "We've seen 30 plus in the valley close. I was in El Paso last week and saw another seven there. So, as these pharmacies close, the patients will have less access to their medication." Martinez wanted to expand his pharmacy, but because profitability is low, expansion is currently on hold. "I have a very large number of employees in order to help care for my patients, I do free deliveries. Some of those expenses will have to seriously get looked at with the types of cuts PBM's are doing."