Supreme Court Declines Review of State PBM Regulation Laws

The regulation of pharmacy benefit managers (PBMs) remains a contentious and evolving issue in the U.S., with recent legal and legislative developments shaping the landscape. The U.S. Supreme Court declined to review a 10th Circuit Court of Appeals decision striking down portions of Oklahoma's PBM law, which conflicted with federal statutes governing Medicare and employer-sponsored health plans, causing confusion among states about their regulatory authority. Nearly three dozen states and D.C. supported Oklahoma's case, reflecting widespread interest in PBM oversight, though the Pharmaceutical Care Management Association (PCMA) praised the court ruling and warned that similar state laws may face legal challenges. Meanwhile, states like Illinois have enacted new restrictions on PBMs, including bans on spread pricing and prohibitions against PBMs directing patients to pharmacies they own, while funding grants to support independent pharmacies; PCMA criticized these efforts for failing to address pharmaceutical pricing. Industry leaders emphasize the critical role of community pharmacies in patient access to care, highlighting state-level reforms as vital in the absence of federal action, and noting that pharmacy closures due to reimbursement issues threaten healthcare access in many communities. These developments underscore the ongoing tension between states' attempts to regulate PBMs to protect patients and pharmacies, and the legal and industry pushback from PBMs and their representatives.