Rep. Jeremiah Moore (right), R-Clarendon, and Sen. Kim Hammer (second from right). R-Benton, listen to opposition to House Bill 1150 from Randy Zook, president of the Arkansas Chamber of Commerce, during the Senate Committee on Insurance and Commerce meeting on Tuesday, April 8, 2025. (Tess Vrbin/Arkansas Advocate)
Two federal lawsuits filed Thursday argue that a new state law will harm hundreds of thousands of Arkansans by affecting access to needed medications.
Two of the country’s largest pharmacy benefit managers (PBMs) filed the complaints in the U.S. District Court for the Eastern District of Arkansas, both arguing that Act 624 of 2025 violates the U.S. Constitution by interfering with interstate commerce. The suits also allege that federal law preempts state laws that affect employee health plans and Medicare coverage.
The suits filed by Express Scripts Inc. and CVS Pharmacy Inc. name the eight members of the Arkansas State Board of Pharmacy and its executive director as defendants. The new law empowers the pharmacy board to enforce its provisions.
Both complaints ask the court to bar enforcement of the law as well as declare it unconstitutional.
Act 624 “imperils the health” of 50,000 Arkansans who rely on Express Scripts for pharmacy benefits through their health insurance, the PBM’s complaint says.
The General Assembly created the law “for the exclusive benefit of Arkansas-based pharmacies who spearheaded the legislation in order to increase their market share by eliminating out-of-state competition,” the complaint states.
Health insurer Cigna owns Express Scripts; CVS Pharmacy owns the PBM Caremark Rx. Together with OptumRx, owned by United Healthcare, the PBMs manage 79% of prescription drug claims for approximately 270 million people, according to a 2024 Federal Trade Commission report.
Arkansas became the first state in the nation to ban large, vertically integrated healthcare companies from also operating drugstores in the state when Gov. Sarah Huckabee Sanders signed House Bill 1150 into law in mid-April. The law doesn’t take effect until January 2026.
“If left to stand, the law will have devastating consequences across Arkansas – including forcing numerous pharmacies operating in the state out of business, costing the more than 600 Arkansans employed at those pharmacies their jobs, and creating pharmacy ‘deserts’ for the nearly 40% of Arkansans who live in rural areas that often lack brick-and-mortar pharmacies,” Express Scripts asserts in its complaint.
“The law will also dangerously limit patient choice and deny access to lifesaving drugs at affordable prices by high-quality pharmacy providers. And it will create mass confusion among Arkansans about where and how they can receive needed prescription medications,” the suit adds.
In its complaint, CVS says that if the law takes effect on Jan. 1, the company “will have to cease not only its operations at 23 CVS retail pharmacies across the State, but also its mail-order and specialty-pharmacy services. Indeed, the law will likely shut down a substantial portion of all mail-order and specialty-pharmacy prescriptions flowing into the State because the majority of such providers are out-of-state pharmacies with PBM affiliations.”
The complaint notes that CVS’s 23 pharmacies served more than 340,000 patients and filled over 2.4 million prescriptions in 2024.
Complying with the law will impose undue burdens on CVS because of the intricacies of its corporate structure, the complaint says. CVS further claims the law already has begun affecting its business, as it has lost patients to in-state competitors and it’s become harder to attract and retain employees in Arkansas.
The CVS complaint calls Act 624 “a blatantly protectionist measure,” a characterization echoed in Express Script’s argument for a court-ordered injunction: “Because Act 624 is unconstitutionally protectionist, unconstitutionally punitive, and preempted by federal law, enforcement of the statute must be enjoined.”
Both lawsuits argue that the Arkansas law violates various commerce provisions of the Constitution, and CVS argues that it violates the equal protection clause by banning CVS and most other PBM-affiliated pharmacies from Arkansas while exempting “the only Arkansas-based pharmacy affiliated with a PBM [Walmart], without a rational justification for this distinction.”
Express Script’s complaint also notes that Act 624 will adversely affect members of the military, their families and veterans because the PBM is the primary mail-order pharmacy provider for Tricare, the military’s health insurance program.
The law allows the state pharmacy board to issue limited permits to PBMs if they provide “drugs that are otherwise unavailable in the market to a patient or a pharmacy that would otherwise be prohibited” under the law. Republican Sen. Kim Hammer of Benton, the law’s co-sponsor, told the Senate this will allow Tricare beneficiaries to continue receiving medications while PBMs transition out of Arkansas.
Attorney General Tim Griffin said in a statement that “Arkansas is standing up to PBMs on behalf of consumers” via Act 624 and vowed to defend the law.
“Pharmacy benefit managers wield outsized power to reap massive profits at the expense of consumers. The rise of PBMs as middlemen in the prescription drug market has resulted in patients facing fewer choices, lower quality care, and higher prices. PBMs leverage their affiliated pharmacies to manipulate prices, corrupt the market, and destroy competition,” Griffin said, echoing many of the talking points of the law’s proponents as it made its way through the Legislature.
Shortly before Act 624 became law, Griffin was the lead signatory of a bipartisan letter to Congress from attorneys general in 39 states and territories, advocating for the policy in Act 624 to be enacted federally.
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