LITTLE ROCK, Ark. — The Pharmaceutical Care Management Association (PCMA), representing 20 PBMs, including market giants CVS Caremark, Express Scripts, and OptumRx, is seeking to block Arkansas’s Act 624 and has filed a federal lawsuit against this first-of-its-kind law that would force PBMs to divest from owning or operating pharmacies within the state.
This sweeping law, passed in April, bans companies from simultaneously operating as PBMs and pharmacies within the state. It will take effect on January 1, 2026.
In its lawsuit, filed Monday in the U.S. District Court for the Eastern District of Arkansas, PCMA argues that the law is unconstitutional and could disrupt patient access to medications, particularly mail-order and specialty drugs. The association warns that the law could force the closure of approximately 40 PBM-owned pharmacies in Arkansas, resulting in job losses and increased costs for patients and payers.
“Our lawsuit aims to protect patients in Arkansas from the implementation of this dangerous, misguided policy. If implemented, the Arkansas legislation mandating forced closures of pharmacies would have a devastating impact on patient access to critical medications and pharmacy services. Implementation of the law could eliminate convenient home delivery options for Arkansas patients, including seniors and veterans, severely jeopardize access to treatment for specialty pharmacy patients managing complex and serious conditions, like cancer, and close local retail pharmacies in the state, eliminating high-quality health care jobs and preventing patients from keeping their pharmacist,” PCMA said in a statement.
The suit claims Act 624 violates multiple provisions of the U.S. Constitution, including the Dormant Commerce Clause, the Privileges and Immunities Clause, and the Bill of Attainder Clause. These arguments echo earlier legal challenges brought by major PBMs such as CVS Health and Cigna, which operate Caremark and Express Scripts.
Arkansas Gov. Sarah Huckabee Sanders signed Act 624 in April. The law aims to combat anti-competitive behavior and protect the state’s independent community pharmacies from being squeezed out by vertically integrated PBMs. The legislation reflects growing state-level momentum to crack down on PBM practices amid stalled federal reform.
“PBMs should not be allowed to rig the system to favor their own pharmacies and undermine competition,” Sanders said at the time.
PBMs play a central role in the prescription drug supply chain, managing formularies, negotiating rebates with drugmakers, and processing pharmacy claims on behalf of insurers. Critics argue that their vertically integrated business models — where the same parent company operates the PBM, insurer, and pharmacy — create conflicts of interest and hurt smaller, independent pharmacies.
Navitus Health Solutions, a Wisconsin-based PBM that is not a PCMA member but follows a pass-through pricing model, joined the lawsuit as a co-plaintiff.
The legal outcome in Arkansas could shape the trajectory of PBM regulation nationwide. Vermont, Texas, and New York lawmakers have introduced similar bills to separate PBM and pharmacy ownership, while federal efforts to reform PBM practices have repeatedly stalled in Congress.
However, the issue continues to draw bipartisan attention on Capitol Hill. A GOP-led Senate healthcare package currently under consideration includes PBM-related provisions, such as banning spread pricing in Medicaid and requiring more transparency in how PBMs are compensated.
As the lawsuit plays out, the healthcare and pharmacy sectors will be watching closely, not just for its implications in Arkansas but also for the ripple effects it may have across the country.
