‘Tectonic’ Arkansas PBM Legislation May Upend Industry
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Apr 24, 2025
Arkansas Gov. Sarah Huckabee Sanders (R) on April 16 signed into law a bill that made the state the first to prohibit PBMs from owning or operating pharmacies. Benefits experts and trade groups tell AIS Health, a division of MMIT, that the legislation could have a significant impact on the PBM industry and potentially expand to other states — although they expect the major PBMs to fight back with lawsuits.
If the law goes into effect on Jan. 1, 2026, as intended, PBMs would be forced to divest the retail, mail-order and specialty pharmacies they own in Arkansas if they want to continue doing business as PBMs there. Even if a PBM’s mail order or specialty pharmacy is in another state, it could not deliver prescriptions to Arkansas or care for patients in the state. The legislation, HB1150, would primarily affect the Big Three PBMs of CVS Health Corp.’s Caremark, UnitedHealth Group’s Optum Rx, and The Cigna Group’s Express Scripts, which collectively process 80% of total U.S. prescriptions and have significant pharmacy assets in Arkansas.
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