A series of rulings from the Sixth and Tenth Circuits has thrown state pharmacy laws into chaos. These "any willing pharmacy" laws required corporate benefit managers to grant in-network status to any pharmacy willing to accept their terms. The courts rejected these laws, arguing they interfere with federally regulated health plans. This decision favors pharmacy benefit managers like those owned by CVS and UnitedHealth.

This legal shift deepens the metabolic divide. Independent pharmacies, often the only health hubs in working-class neighborhoods, are being squeezed out by corporate gatekeepers. In China, the National Medical Products Administration has approved LEO Pharma’s Enstilar for plaque psoriasis. While Western firms consolidate control over drug distribution, the Global South is forced into new dependencies. The infrastructure of care is being enclosed by the same corporate logic that governs the rare earth mines of Brazil.