What the Arkansas PBM Ownership Ban Means for Plan Sponsors
July 2025
The battle unfolding in Arkansas between two of the country’s largest PBMs, Express Scripts and CVS Caremark, and the state government is more than pharmacy ownership. It is about transparency, accountability, and who ultimately controls the pharmacy benefit supply chain.
At Crystal Clear Rx, we help clients see through the noise. Let us break this down.
What Happened? In April 2024, Arkansas passed a law banning PBMs from owning pharmacies within the state (House Bill 1150). The goal is to dismantle the vertical integration that gives large PBMs the ability to both manage pharmacy networks and profit from dispensing medications through their own pharmacies. Express Scripts (part of Cigna) and CVS Caremark (part of CVS Health) filed lawsuits to block the law, arguing it violates the U.S. Constitution and harms patients and federal programs alike.
Why It Matters to Payers Vertical integration in the PBM space has long raised concerns:
• Conflicts of Interest: PBMs can prioritize their own pharmacies, often at the expense of patient choice, pricing transparency, or independent pharmacy access.
• Opaque Pricing: Rebates, spread pricing, and reimbursement strategies often benefit the PBM and its affiliates, not the plan sponsor.
• Limited Accountability: When PBMs own the pharmacies, it is difficult for plan sponsors to independently audit performance, pricing accuracy, and contract compliance.
This law challenges that structure. While the legal debate will continue, it signals a growing willingness by states to confront entrenched PBM practices.
What PBMs Say vs. What Employers Should Know PBMs argue the law will restrict access and increase costs. But let us be clear:
• PBMs control the MAC (Maximum Allowable Cost) lists, which determines how much pharmacies are reimbursed for generic drugs. These lists are often not transparent, and PBMs can apply different MAC pricing to different pharmacies, including potentially better rates for those they own. This creates an uneven playing field and inflates margins behind the scenes.
• PBMs decide which pharmacies are in-network and which are not. If a PBM chooses to exclude its own pharmacies from the Arkansas market in response to this law, any disruption to member access is a direct result of that choice, not a mandate of the law.
Our Take: What Plan Sponsors Can Do Right Now
1. Audit your PBM relationships. Use third-party tools like Crystal Clear Rx’s Confirm Rx to verify that pricing, rebates, and clinical protocols are aligned with your contract. It’s about making knowledgeable and informed decisions with a benefit that can be up to 25 % of your total medical spend.
2. Ask the hard questions. Who owns the pharmacies in your network? Who benefits from each transaction?
3. Demand transparency. Pass-through pricing, full rebate disclosures, and open access to claims data should be non-negotiable.
Bottom Line Whether Arkansas wins this legal fight or not, the message is clear. The era of unchecked PBM vertical integration is being challenged. Employers, unions, and public plans do not have to wait for legislative change to act. You can take control of your pharmacy benefits now.
At Crystal Clear Rx, we give you the insight to do just that.
Ready to take control of your PBM oversight? Visit crystalclearrx.com or Contact Us learn how Crystal Clear Rx can uncover savings, ensure contract compliance, and help you make informed, transparent pharmacy benefit decisions.
Citation
Jones, D. N. (2025, May 30). CVS, Express Scripts sue to block Arkansas law barring PBM ownership of pharmacies. Reuters. https://www.reuters.com
Bell, A. (2025, May 30). Express Scripts, CVS sue Arkansas over PBM pharmacy ownership ban. BenefitsPro. https://www.benefitspro.com
AR HB1150 | 2025 | 95th General Assembly. (2025, April 16).
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