In a move that has rocked the pharma industry, Arkansas has passed the nation’s first‑of‑its‑kind law banning Pharmacy Benefit Managers (PBMs) from owning or operating their own pharmacies. The new law, which will officially take effect on January 1, 2026, seeks to prevent conflicts of interest, inflated drug prices, and anticompetitive behavior—including negative impacts on independent pharmacies that have driven some out of business.
This aggressive push for PBM reform echoes efforts being advocated at the federal level. In April, President Trump signed an executive order that includes measures to improve transparency into pharmacy benefit‑manager fee disclosures. The order requires the Secretary of Labor to issue regulations that will improve employer health‑plan fiduciary transparency into the direct and indirect compensation received by PBMs.
Industry Impacts
While the impetus for PBM reform on the federal level has been happening for some time now, the Arkansas law is sudden and sweeping. But what does it actually mean for the broader PBM space?
Operational Adjustments
It’s safe to say that large PBMs—including CVS Caremark, OptumRx, and Express Scripts—are watching the developments in Arkansas very closely. Affiliated with major health insurers, they control about 80 percent of the prescription‑drug market, and these new regulations will impact the way they do business in Arkansas significantly. This could include divesting from owned pharmacies and reevaluating their business models to comply with the new law. Such changes may lead to increased operational costs and potential disruptions in service delivery.
Financial Implications
The law could affect the financial dynamics of PBMs operating in Arkansas. Without the ability to own their own pharmacies, PBMs may lose a revenue stream, potentially impacting their profitability. Additionally, the requirement to reimburse pharmacies at or above the National Average Drug Acquisition Cost (NADAC) could increase expenses.
Legal and Regulatory Challenges
The PBM industry may pursue legal avenues to challenge the Arkansas law, arguing that it conflicts with federal regulations or disrupts established business practices. However, previous legal battles in Arkansas—such as the the Supreme Court’s unanimous decision upholding state regulations on PBM reimbursements—suggest there is a strong legal foundation for the law to stand on.
Industry Precedent
While the Pharmaceutical Care Management Association (PCMA) openly criticized the Arkansas law, citing concerns over reduced access and higher health‑care costs—other states, including Vermont, Texas, and New York, have recently introduced similar legislation. Will others follow suit? That remains to be seen.
Benefits to the Independents
Pharmacies in Arkansas will financially benefit from the new law, especially independent pharmacies in more rural areas that have been at risk of closing for years due to unfair PBM reimbursements.
The US‑Rx Care Difference
US‑Rx Care is a different kind of Pharmacy Benefit Manager. As an independent PBM, we deliver true fiduciary‑first pharmacy risk management to self‑insured employers with a singular focus on balancing cost and quality care. Everything we do is always in the best interest of our clients and their plan members—no financial conflicts of interest, no hidden profits, and total, unrestricted transparency.
Want to find out the difference a fiduciary‑first approach to PBM can make for you and your business? Let’s talk. Reach out now!
Schedule a meeting at usrxcare.com/contact.