PBMs Sue Arkansas Over Pharmacy Ownership Prohibition

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On June 9, the Pharmaceutical Care Management Association (PCMA), a national association representing pharmacy benefit managers (PBMs), and Navitas Health Solutions, a PBM, filed a lawsuit challenging Arkansas’ first-of-its-kind law that prohibits PBMs from owning pharmacies in the state.  

The law——prohibits PBMs from having a “direct or indirect interest in” or otherwise holding a permit to operate a pharmacy in the state, starting January 1, 2026. In practice, this means that no pharmacy in which a PBM has a direct or indirect interest will be allowed to acquire or maintain a permit or license to operate a pharmacy in the state. The law also directs the Arkansas State Board of Pharmacy to either revoke or not renew a pharmacy permit of an entity that violates this prohibition.

PCMA and Navitas argue that the law violates several constitutional principles that restrict states from engaging in “economic protectionism.” According to the plaintiffs, once the law takes effect, all PBM-affiliated mail-order and specialty pharmacies that operate outside of Arkansas and ship drugs into the state will lose their permits or licenses, while no company that is domiciled or headquartered in Arkansas will lose or be denied a permit or license as a result of the law. PCMA and Navitas argue that because the intent and practical effect of the law is to shield local pharmacies from competition from out-of-state PBMs and pharmacies and punish this discrete set of companies, it violates the core constitutional prohibition against state laws that advantage in-state economic interests at the expense of out-of-state competitors.

PCMA and Navitas’ lawsuit is now the third filed challenging Arkansas’ law, joining CVS Health and Express Scripts in making similar constitutional arguments. These legal challenges are poised to serve as a bellwether for how courts will view state efforts to prohibit PBM ownership of pharmacies and could shape the extent to which other states follow Arkansas’ lead. Similar laws are being considered in other states, including , , and .

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