News/Blogs

The ground under pharmacy benefits shifted again this summer, and it’s moving in more than one direction. Federal appeals courts handed down split decisions on how far states can go in regulating PBMs serving self-funded plans. A judge paused Illinois’ new reporting rules for employer and union plans. Arkansas and Tennessee laws targeting PBM-owned pharmacies are still tied up in court. Meanwhile, Washington is laying the groundwork for new compensation and transparency requirements that arrive in 2028. Here’s a quick look at the developments most likely to affect the plans you advise, and what they could mean for your clients’ pharmacy benefit strategy. 

Litigation

• The Eighth Circuit U.S. Court of Appeals, in Flowers v. Caremark PCS Health, LLC, held that Arkansas’ geographic network adequacy standards are preempted by ERISA. 

• The Seventh Circuit Court of Appeals affirmed in Central States SE & SW Areas Health & Welfare Fund v. McClain that ERISA does not preempt Arkansas requirements for pharmacy reimbursement and related reporting. 

•  A federal district court temporarily blocked reporting requirements under Illinois’ Prescription Drug Affordability Act (PDAA) as applied to PBMs serving self-funded employers and union-sponsored health plans. 

• The Eighth Circuit Court of Appeals heard oral arguments over Arkansas Act 624, which would prohibit PBMs from owning or controlling pharmacies within the state.  

• Multiple entities continue to challenge Tennessee SB 2040 in federal district court. The law restricts ownership of pharmacies by entities that also own or control a health insurer and a PBM. The law is scheduled to take effect on July 1, 2028.  

Federal action

• CMS issued an RFI seeking input on PBM compensation, affiliate arrangements, and data collection requirements added by Section 6224 of the Consolidated Appropriations Act, 2026. The new requirements take effect in 2028. 

• The White House announced nine new agreements with pharmaceutical manufacturers, with the goal to lower prescription drug prices for Americans and support pharmaceutical manufacturing and supply-chain reserves. 

• The Trump administration finalized updates to the Transparency in Coverage rules to improve the accuracy and usability of health plan pricing data. The changes refine machine-readable file requirements and expand access to cost-sharing information, with the goal of making pricing data more useful to employers, consumers, and other stakeholders.  

About Serve You Rx®   
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.