PULSE 5-23-26 Tennessee Gov Bill

Executive summary

This report covers the following key findings:

1. Nearly half of respondents (47.2%) report mixed feelings about the law, reflecting a real tension between supporting competition and fearing reduced pharmacy access — not mere indifference. This plurality dwarfs both the pro-law (23.9%) and anti-law (22.9%) camps, suggesting the dominant public posture is cautious ambivalence. Respondents who expressed neutral trust in large corporations were disproportionately likely to land in the 'mixed feelings' category, confirming that corporate skepticism alone does not resolve the access-versus-competition dilemma. Any communication strategy that treats this audience as simply pro- or anti-regulation will miss the majority.

2. More than half of respondents (53.0%) say price and insurance coverage is the most important factor when choosing a pharmacy, far outpacing convenience (25.6%) and personal service (18.1%). This finding means that debates about the FAIR Rx Act will be won or lost on cost narratives: if the law is seen as lowering drug prices by curbing PBM self-dealing, it gains support; if it is seen as disrupting insurance networks and raising out-of-pocket costs, it loses support. External evidence that CVS Caremark paid affiliated pharmacies up to 16,000% more than independents for identical drugs directly feeds the cost-impact argument for the law. Communicators should lead with price effects rather than structural or constitutional arguments.

3. Nearly one in four respondents (22.9%) oppose the law specifically because it could reduce pharmacy access, a concern that external evidence validates: Tennessee already has approximately 650,000 households in pharmacy deserts, is one of only eight states that experienced a net loss of pharmacies between 2010 and 2020, and CVS has warned of 134 store closures if forced to divest. The NCPA-USC tool confirms roughly 1 in 8 U.S. neighborhoods persistently lack convenient pharmacy access, with rural and low-income areas most exposed. This access-risk segment is not fringe; it represents a substantive policy concern that the law's supporters must address directly to build broader coalitions.

4. Free-response analysis reveals a strong lean toward the view that pharmacies should be independent from drug manufacturers and insurers, with process simplicity also valued highly. This attitudinal baseline is favorable terrain for the FAIR Rx Act's core prohibition, even among respondents who express mixed feelings about its practical consequences. The preference for ownership independence aligns with documented public skepticism toward large healthcare corporations and with FTC findings that vertically integrated PBMs use market position to disadvantage independent pharmacies. Messaging that frames the law as restoring pharmacy independence — rather than as a regulatory intervention — is likely to resonate with the broadest audience.

5. Respondents broadly distrust large corporations to prioritize patient needs over profits, consistent with national data showing nearly two-thirds of Americans believe pharmaceutical companies prioritize profits over health. However, this distrust does not straightforwardly translate into support for the FAIR Rx Act: neutral corporate-trust respondents cluster in the 'mixed feelings' category rather than the 'support' category. This suggests that anti-corporate sentiment is a necessary but not sufficient condition for law support — respondents also need reassurance that the law will not harm their own access or costs before converting skepticism into endorsement.

6. CVS filed a federal lawsuit within hours of the law's signing, warning of 134 pharmacy closures, 25 MinuteClinic closures, and more than 2,000 healthcare job losses in Tennessee. A parallel legal battle in Arkansas over a similar law is already before the Eighth Circuit, and California's SB 41 faces ERISA preemption challenges, meaning the constitutional and regulatory landscape is unsettled. This legal uncertainty is a plausible driver of the 47.2% 'mixed feelings' response: respondents may support the law's goals while doubting its durability or fearing its near-term disruptions. Stakeholders should monitor litigation outcomes as a leading indicator of whether public ambivalence resolves toward support or opposition.

7. Respondents scoring higher on the Ocean Neuroticism trait tend to feel more positively about the FAIR Rx Act, while more extraverted respondents are less likely to select non-standard pharmacy priorities. This pattern suggests that individuals who are more attuned to risk and systemic threats — a hallmark of higher neuroticism — may be more receptive to the law's framing as a protective measure against corporate overreach. Conversely, the law's opponents and ambivalent respondents may be more pragmatically oriented, weighing concrete access risks over abstract structural concerns. Audience segmentation by risk sensitivity could sharpen both advocacy and opposition messaging.

Context

Scope: Echo Intelligence fielded [PULSE 5-23-26] Tennessee Gov. Bill Lee signs law banning PBM-owned pharmacies with 4 question(s) and 218 responses when this snapshot was captured.

Signal focus: The clearest quantitative signal in this wave comes from questions such as: Tennessee Governor Bill Lee signed a law banning pharmacy benefit managers from owning pharmacies, which CVS says could force them to close stores in the state. How do you feel about this change?

Interpretation frame: Results below should be read as directional evidence from this sample, not a census of the whole market.

Conclusion

What to watch: whether the top finding in this wave shows up again as more responses arrive and whether the gap between groups widens or narrows.

• Public Is Genuinely Conflicted, Not Simply Polarized, on the FAIR Rx Act: If this pattern proves stable, it should inform the next decision on where to lean in.

• Price Dominates Pharmacy Choice, Making Cost-Impact Arguments Central to Public Persuasion: If this pattern proves stable, it should inform the next decision on where to lean in.

Practical takeaway: treat these results as a sharp snapshot—use them to decide what to validate next, not as a final verdict.