CVS, Cigna sue Arkansas over PBM ban

Everyone knows PBMs are a problem, the question is what to do about them. I guess that's why they call the states laboratories of democracy.

Michigan passed a big package of PBM licensing bills to empower hands-on government control. (Good luck with sustainable affordable drugs coming out of that.)

Congress proposed a their idea of a nationwide solution.

I kinda like Arkansas' direct approach.

But truth be told, as public awareness grows, and names are attached to practices, I think PBMs are losing public trust in favor of independent pharmacies. Hopefully independents will gain market share, given half a chance and less regulatory burden.

https://www.healthcare-brew.com/stories/2025/06/10/cvs-cigna-sue-arkansas-pbm-ban

CVS, Cigna sue Arkansas over PBM ban

PBMs have reportedly raised drug prices and contributed to local pharmacy closures. But CVS is threatening to close more in Arkansas.

Cassie McGrath    |    June 10, 2025

Let the battle commence…

CVS and Cigna’s pharmacy benefit managers (PBMs), Caremark and Express Scripts, respectively, are suing Arkansas after the state signed a bill on April 16 that would ban vertical integration between PBMs and pharmacies. The companies filed two separate lawsuits on May 29, claiming the Arkansas law is unconstitutional and “unenforceable.”

In other words, companies that own PBMs (which negotiate medication prices between drug manufacturers and pharmacies) cannot also operate pharmacies in the Natural State starting Jan. 1, 2026. This is a problem since the three largest PBMs all own pharmacies.

As a result of the bill, CVS threatened to close its 23 retail pharmacies in Arkansas, which the healthcare giant said would reduce patients’ access to medications. CVS serves about 340,000 patients in the state, according to the Arkansas Times.

Cigna also claimed the law “will likely force some retail pharmacies to close” in a press release on May 29.

In the release, Susan Peppers, VP of pharmacy practice at Evernorth Health Services, Cigna’s health services organization, said “hundreds of thousands of Arkansans” would lose access to pharmacies and medications.

Rajiv Leventhal, senior analyst in digital health at research firm eMarketer, told Healthcare Brew these suits are “a very predictable response” to the law, as it would definitely have a “big effect on [PBM] business.”

Let’s run it back. The country’s three biggest PBMs—Caremark, Express Scripts, and UnitedHealth Group’s Optum Rx—administer 80% of the drugs prescribed in the US. Meaning they also have a lot of control over prices.

Rising drug prices can be linked to PBMs, according to the Federal Trade Commission, which has a lawsuit against the three giants. PBMs have also been cited as a reason independent pharmacies are closing across the country, including 20 closures in Arkansas in the last year, Stat reported.

Sam Dubke, spokesperson for the office of Gov. Sarah Huckabee Sanders, told us the governor is “proud” to be the first state to take on PBMs’ “anticompetitive practices.”

“These big drug middlemen are only attacking Arkansas in the courts because they’re worried other states will join Governor Sanders in fighting for patient access and affordable prescriptions,” he said.

The pressure is on. Leventhal said PBMs have never faced such a “tough decision” through a law before.

“The PBMs just have way too much influence over pharmacy reimbursement, over which medications patients can access and at what cost,” he said.

While Arkansas has certainly made a statement with this law, Leventhal said we’ll have to wait to see how the lawsuits play out to determine its effect on the industry. Though, he added, he’s also unsure whether the law will hold up because “some of the arguments that CVS and Cigna have made in their lawsuits…could look pretty convincing in court.”

“There’s definitely enough appetite and willingness at the state and federal level to make sure that PBM influence and power does get mitigated, at least a little bit,” Leventhal said.