SCOOP: PBMs under fire from Republicans across the country
The Reporter recapped the latest actions targeting PBMs across America.
In 2025, a new front opened in the war over healthcare costs, with Republicans joining Democrats in focusing on Pharmacy Benefit Managers (PBMs) as one of the drivers of high costs for prescription drugs. PBMs are the firms that are hired by employers and insurers to negotiate prices with drug manufacturers.
Proponents of PBMs, like former Secretary of State Mike Pompeo and former Sen. Pat Toomey (R., Pa.) argue that they are private market forces that put downward pressure on the price of drugs. Opponents argue that PBMs distort the free market, and the complicated pricing practices prevent customers from knowing the true cost of drugs — a necessary feature of any free market. The result, lawmakers argue, is a complicated, confusing system that drives prices up for consumers and squeezes out local pharmacists.
At the federal level, lawmakers are beginning to apply new scrutiny to companies like CVS that have both pharmacy and PBM business lines. In Arkansas, lawmakers have moved aggressively to draw a line in the sand.
Arkansas now stands at the forefront of state efforts to rein in pharmacy benefit managers. On April 16th, 2025, Gov. Sarah Huckabee Sanders (R., Ark.) signed HB1150, now Act 624, making Arkansas the first state in the nation to prohibit PBMs from owning or operating pharmacies within its borders.
The law accomplishes this by barring PBMs from obtaining the pharmacy permits necessary to operate brick-and-mortar or mail-order pharmacies beginning January 1st, 2026. In the words of the sponsors, the aim is to “minimize conflicts of interest by stopping the pharmacy benefit managers from acting as a ‘fox guarding the hen house’ by being both a price setter and a price taker.”
Sanders framed the law as a long-overdue reckoning with industry abuses stating, that “for far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications. Not anymore,” she said. “These massive corporations are attacking our state because we will be the first in the country to hold them accountable for their anticompetitive actions.”
The Arkansas Pharmacists Association, which represents many independent operators across the state, endorsed the measure as a step toward preserving local pharmacy access and ensuring fair reimbursement.
PBMs and CVS (through its PBM Caremark) responded swiftly with lawsuits. Express Scripts have sued to overturn the law, arguing it would shutter pharmacies, reduce access, and violate constitutional protections such as the Commerce Clause. CVS and Caremark have also joined the litigation.
In July 2025, a federal judge temporarily blocked the law from taking effect, ruling that it may discriminate against out-of-state companies and likely violates the U.S. Constitution’s Commerce Clause. Arkansas Attorney General Tim Griffin pledged to appeal.
Still, even as the law is paused, the move has galvanized support and attention, and Arkansas now occupies a starring role in the national PBM reform debate.
One outstanding question is how much disruption the law would cause to pharmacy access, especially in rural or remote areas. Some critics (and PBM defenders) argue the law could force closures , diminish home-delivery services, or hamper specialty pharmacies. Proponents counter that the measure protects the long-term viability of independent pharmacies by curbing the abusive advantage integrated PBMs currently enjoy.
In effect, Arkansas is staking a clear claim: No longer will PBMs be allowed to dominate both ends of the drug supply chain in the state. Whether that holds up in court could determine if other states follow.
Arkansas may currently be the most aggressive, but it’s far from alone. In Louisiana, lawmakers considered HB358, which would have banned companies from owning both PBMs and pharmacies, a direct challenge to CVS’s business model. While that bill ultimately stalled, a more modest compromise (HB264) passed, requiring greater transparency from PBMs and mandating that savings be passed through to consumers.
In June 2025, CVS sent a mass text to customers in Louisiana, warning that legislation like HB358 could force closures and raise drug costs. That triggered an investigation by House Republicans and a potential HIPAA complaint over the use of patient data to lobby. Gov. Jeff Landry (R., La.) pledged to reintroduce more aggressive legislation in a special session.
Earlier in 2025, Oklahoma Attorney General Gentner Drummond filed a formal complaint against CVS Caremark, accusing it of under-reimbursing 15 independent pharmacies. The suit alleges that for about 200 prescriptions, payment was less than acquisition cost, a violation of state law. Under Oklahoma’s law, the state may seek fines of up to $10,000 per violation or revoke the PBM’s license.
Several other states are also actively investigating or enacting PBM reforms. Over the last decade, every state has passed at least one law aimed at PBMs (restricting spread pricing, requiring more transparency, or regulating reimbursements). States such as Vermont, Kentucky, Ohio, California, and Hawaii have been part of lawsuits or regulatory scrutiny targeting PBMs. After Arkansas’s move, some states, like Indiana, are considering “look-alike” restrictions that would prevent PBMs from owning pharmacies or require separation from vertical ties.
Republican policymakers across Arkansas say the fight against PBMs’s abuse is long overdue.
Representative Brandon Achor, a pharmacist, cancer survivor, and state legislator from Central Arkansas, has been an outspoken voice against PBM overreach. Achor told the The Reporter that “as a legislator, healthcare provider, and cancer survivor, I have seen the abuse and extortion by PBMs from every angle. A PBM’s core function is to balance a sustainable diversity of fair network access for its clients members while lowering net drug spend.”
“What we have seen from the FTC investigations, Congressional House Oversight Committee investigations, reports from the Wall Street Journal and from the New York Times, dozens of state-plan audits across the country, and as recent as this past legislative session in Arkansas, is not only the PBM’s failure to increase access and lower prices, but rather a self-dealing and vertically-integrated choking of market access while growing the drug spend,” Achor said. “I am proud to have stood alongside my colleagues in the legislature under the bold and patient-focused leadership of Governor Sarah Huckabee Sanders and emphatically declared that ‘Arkansas isn’t scared and we’ve seen enough.’”
Achor’s remarks echo the frustration of pharmacists nationwide who say PBMs have turned a cost-control function into a profit-maximizing monopoly. Investigations and audits have consistently shown that PBMs often pocket undisclosed rebates, steer patients toward their own pharmacies, and reimburse independents below cost — all practices that inflate prices for consumers and crush local competition.
Senate President Pro Tempore Bart Hester, one of the state’s most influential Republicans, echoed Achor’s warning but emphasized the need to craft reforms that remain pro-business and targeted. Sen. Hester told the The Reporter that “Arkansas has taken a strong stance against PBMs. There is no doubt there are some harmful practices. Moving forward, we need to take a close look and make sure that as we are solving some problems, we are not causing other harm for Arkansas businesses and their employees.”
Hester’s comments reflect a pragmatic strand of Republican leadership, one that seeks to confront corporate abuse without stifling market innovation. The shared goal, however, remains clear: to dismantle the conflicts of interest that have allowed companies like CVS Caremark to dominate both the drug distribution and pricing chain.