Pharmacy Benefit Managers (PBMs) act as intermediaries between drug manufacturers, pharmacies, health plans, and patients. They negotiate rebates, manage formularies, and handle prescription reimbursements. However, critics argue that PBMs often prioritize profits through practices like spread pricing, rebate retention, and steering patients to affiliated pharmacies, which drives up costs and squeezes independent pharmacies. In response, several states have enacted bold reforms to promote transparency, fairness, and cost savings. As of early 2026, these efforts vary in scope and aggressiveness, with some facing legal hurdles. Below, we explore recent state PBM reforms, highlighting their key provisions and impacts. West Virginia has been at the forefront of PBM oversight, emphasizing licensure, fair practices, and direct benefits to consumers. PBMs and auditing entiti…

Arkansas took a hardline stance on PBMs with Act 624 (HB 1150), enacted in 2025 and slated for Jan. 1, 2026, implementation. Sarah Huckabee Sanders, the law bans PBMs from owning or operating retail or mail-order pharmacies, targeting vertical integration and “self-dealing” where PBMs steer patients to their own facilities. However, the reform hit a snag when a federal judge issued a preliminary injunction on July 28, 2025, citing constitutional concerns, including potential violations of the Commerce Clause and conflicts with federal programs like TRICARE. Major PBMs such as CVS Caremark, Express Scripts, and OptumRx challenged the law in court, arguing it oversteps state authority. The legislation includes a narrow exception for pharmacies handling rare or specialty drugs, but is otherwise one of the most stringent state-level attacks on PBM influence. If upheld, it…