United Pharmacy Coalition

2025 ftc PEtition

States Attempting PBM Legislation

Most states have taken some PBM action (licensing, transparency, anti-clawback rules), but only a minority passed the most aggressive reforms (ownership bans, delinking compensation, or guaranteed full rebate pass-through) by mid-2025 — and several states saw promising bills stall or be blocked by courts. Legal risk (ERISA/commerce clause), industry lobbying, cost/access trade-offs, and political calculus are the main reasons for the slower, state-by-state pace. (NASHP)


1) Texas — strong bills introduced but did not pass

  • What happened: Texas lawmakers introduced HB 5457 in 2025 (would have prohibited PBMs from controlling/affiliating with pharmacies), but the bill stalled in committee / did not pass. Texas has passed some smaller pharmacy-related bills, but a sweeping ownership ban/delinking reform did not clear the legislature in 2025. (LegiScan)

2) New York — proposals introduced but not enacted (as of mid-2025)

  • What happened: New York legislators introduced bills (e.g., A6546 / A06546) that would ban PBM ownership/control of pharmacies, but those measures remained in the bill process (introduced/referred) rather than enacted during the 2025 session. New York does regulate PBMs (licensing/reporting), but the high-impact ownership bans/delinking measures were not adopted as law in that session. (New York State Senate)

3) Vermont (example of a bill that failed to advance)

  • What happened: Vermont considered legislation like H156 to prohibit PBM ownership of pharmacies, but the bills failed to move out of committee in 2025. Several small states have introduced ownership-ban bills that did not advance. (Multiple tracking reports note bills introduced in states that did not pass.) (Avalere Health Advisory)

4) Several other states: partial/limited action rather than sweeping change

  • What to know: By late-2024 / 2025 virtually every state had some PBM-focused law or regulation (reporting, licensing, anti-clawback measures), but relatively few had adopted the most aggressive package of reforms (ownership bans + delinking + mandated full rebate pass-through). NASHP and legislative trackers show broad, but highly variable, activity — many states passed incremental transparency or anti-steering rules while leaving ownership/delinking questions unresolved. In short: the absence of a sweeping change in a state often means “partial” reforms, not a blank slate. (NASHP)

 



Evidence-based reasons those states (and others) haven’t enacted sweeping patient-choice reforms

1) Legal risk — ERISA preemption and interstate commerce concerns

  • Many states worry their laws will be struck down or preempted because of ERISA (which limits state regulation of employer-sponsored, self-insured plans) or Commerce Clause/constitutional challenges. Courts already halted or enjoined key state provisions (e.g., federal challenges to Arkansas/Iowa provisions and the 10th Circuit/related litigation) — that legal uncertainty chills legislatures from passing big, novel rules. (Segal)

2) Active industry opposition / lobbying pressure

  • PBMs, big insurers and integrated pharmacy chains lobby heavily against ownership bans / delinking — arguing such laws will raise costs, restrict mail-order access, or force network disruption. That industry influence makes legislators cautious, especially where campaign dollars, local jobs tied to corporate pharmacy operations, or insurer concerns loom large. (Fierce Healthcare)

3) Concerns about increased short-term costs or access disruption

  • Opponents warn (and some analyses suggest) that sudden changes — especially ownership bans or forced pass-throughs — could raise plan costs for employers, lead to network disruptions, or cause some large vertically integrated players to withdraw pharmacies or services, at least temporarily. Those cost/access trade-offs make some states prefer incremental or conditional approaches. (Bloomberg Law)

4) Political / legislative priorities and partisanship

  • PBM reform competes with many other priorities. In politically divided legislatures, big structural changes — especially those that invite expensive litigation — are less likely to pass. Some states prefer smaller transparency or audit laws rather than sweeping structural reforms. (See legislative trackers showing many “partial” reforms.) (Optum for Business)

5) Variation in local pharmacy market structure & state context

  • States differ in how dependent they are on PBM-owned or mail-order pharmacies, on self-insured employer penetration, and on rural vs. urban pharmacy density. Where the political or economic footprint of integrated players is large, lawmakers are more cautious about sudden disruptive rules. Legislative texts and state reports often show tailored, modest fixes instead of broad national models. (MultiState)

 

States considering new laws in 2025

All 50 states are holding sessions during 2025 to consider passage of new laws. As of March 2025, state legislatures have introduced more than 1,250 bills on PBM and prescription drug benefit issues. By comparison, there were 635 bills introduced in 2024 and 658 bills introduced in 2023.

Many states have introduced individual bills that include multiple provisions impactful to PBMs or prescription drug benefits. Commonly, this type of omnibus legislation includes mandates related to pharmacy reimbursement, pharmacy networks, traditional/spread pricing, and rebates.

States that have introduced at least one omnibus bill include Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Montana, Nebraska, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon and Wisconsin. Alabama, Indiana, Missouri and Nevada are among the states that have introduced multiple omnibus bills.

 

Bills in progress

The legislative process of hearing bills in committee and passing bills through chambers of the legislature continues. The following are examples of bills that have passed through one chamber of a state’s legislature:

The Colorado House passed and advanced to the Senate HB 1094. The bill includes provisions that mandate pharmacy reimbursement at NADAC plus a reasonable and adequate dispensing fee.

The Indiana Senate passed SB 140, and the bill is now under consideration by the House. Among its provisions are a NADAC pharmacy reimbursement mandate plus dispensing fee of $10.64 and non-PBM-affiliated pharmacy reimbursement parity. This bill also bans mandatory mail or exclusive specialty, prohibits retroactive recoupments and reconciliation processes. A PBM licensed in the state would also be banned from having an ownership interest in a pharmacy. This pharmacy ownership provision could prevent PBMs from offering home delivery of prescriptions or specialty prescriptions from being mailed into the state. The Indiana Senate also approved HB 1604 which would require health insurers to allow coupons to be used against cost sharing requirements for prescription drugs. The legislation returns to the House for concurrence.

The Mississippi Senate passed HB 1123 which bans spread pricing and includes anti-steering provisions. The bill also modifies requirements around MAC list pricing, and prohibits retroactive reduction of claims payments. The House will now consider whether to concur with the Senate’s version of the bill. 

In Oklahoma, the Senate approved SB 789, which would modify pharmacy audit requirements, ban effective rate contracting, and require PBMs to reimburse pharmacies for each drug dispensed at no less than 106% of the National Average Drug Acquisition Cost (NADAC), plus a $15.00 dispensing fee. The legislation now advances to the House for consideration.

Iowa, Missouri and Oklahoma House of Representative chambers have passed prior authorization bills which will now be considered by each respective state’s Senate chamber.

  • Iowa HF 303 would establish maximum response times for prior authorization requests and mandate health plans develop a gold carding program without specifying a threshold or standard.
  • Missouri HB 618 would establish a gold carding program that requires a 90% threshold for approved claims and providers must be in network for one full year before being considered for the program.

Oklahoma HB 1808 would reform prior authorization practices for prescription drugs and requires prior authorization requests approved for drugs used to treat chronic conditions to be valid for three years, except for opioids, controlled substances, and weight loss drugs. In order to become law, a bill must pass through both chambers of a legislature and be signed into law by the state’s Governor.