CVS Health and Express Scripts are suing Arkansas over a new law banning pharmacy benefit managers from owning pharmacies, arguing it violates the Constitution and threatens access to care.
At a Glance
- CVS Health and Express Scripts filed federal lawsuits against Arkansas
- The law bans PBMs from owning or operating pharmacies in the state
- Companies argue it violates the Dormant Commerce Clause and federal law
- Arkansas claims the law protects consumers from inflated drug prices
- Industry experts warn of national implications if the law is upheld
Constitutional Collision
Two of the largest pharmacy benefit managers in the U.S., CVS Health and Express Scripts, have filed federal lawsuits challenging a bold new Arkansas statute that could force them out of the state’s retail pharmacy market. The law, scheduled to take effect on January 1, 2026, would prohibit PBM-owned or -affiliated pharmacies from operating in Arkansas.
The companies argue the measure violates multiple constitutional provisions, including the Dormant Commerce Clause, the Privileges and Immunities Clause, and the Bill of Attainder Clause. They also say it conflicts with federal laws like ERISA, Medicare, and TRICARE that govern how prescription drug benefits are administered nationwide.
“If left to stand,” Express Scripts warned in its complaint, “the law will have devastating consequences across Arkansas — including forcing numerous pharmacies operating in the state out of business.”
Watch a report: CVS, Express Scripts sue to block Arkansas PBM ban.
State Pushback and Political Stakes
Arkansas Attorney General Tim Griffin, a staunch supporter of the new statute known as Act 624, says the law is a consumer protection measure. “Through Act 624, Arkansas is standing up to (benefit managers) on behalf of consumers,” he declared, promising to vigorously defend it in court.
Supporters argue that PBMs exploit their dual role as middlemen and retail competitors, manipulating formularies and reimbursement rates to disadvantage independent pharmacies. A recent FTC report found that PBMs contribute to rising drug prices and reduced transparency in the pharmaceutical supply chain.
John Vinson, CEO of the Arkansas Pharmacists Association, suggested that PBM-affiliated pharmacies still have options—like surrendering their PBM license or transferring control to non-affiliated entities—but warned that the legal challenges were predictable. “I am not surprised that they’ve sued,” he said. “The (benefit managers) for a decade have had a track history of suing just about every step of the way.”
A National Precedent in the Making
The stakes extend far beyond Arkansas. If the law survives legal scrutiny, it could embolden other states to enact similar restrictions, potentially reshaping the PBM-dominated landscape of drug pricing and distribution across the country.
CVS Health and Express Scripts contend that such state-level interventions threaten the efficiency of a national pharmacy network and could fragment care delivery. Yet independent pharmacists and consumer advocates argue that limiting PBM power is essential to restoring fairness and affordability in the prescription drug market.
The federal courts now face a pivotal decision: uphold Arkansas’s attempt to curtail corporate pharmacy control, or affirm the national dominance of vertically integrated PBMs. Either outcome could redefine the balance of power in American healthcare.
