Arkansas lawmakers on Friday questioned whether the state Insurance Department is doing enough to enforce laws against pharmacy benefit managers (PBMs), national prescription drug middlemen accused of underpaying local pharmacies.
Daniel Holland, general counsel for the department’s PBM division, told the Arkansas Legislative Council that while pharmacist complaints have declined since a rule requiring “fair and reasonable” dispensing fees took effect in December, nearly one in five health plans still reimburse below the national average drug acquisition cost (NADAC) a violation of state law.
The department identified 12 PBMs in violation, covering about 340,000 Arkansans. Six have been ordered to submit corrective action plans by next month; the others cited confusion or data issues. Fines range from minimal amounts to $5,000, depending on the shortfall, but lawmakers said those penalties may not be enough.
“I’d like the agency to quit pussyfooting around with PBMs,” said Sen. Kim Hammer, R-Benton, urging harsher sanctions.
The PBM market is dominated by OptumRx, Express Scripts and CVS Caremark, which handle nearly 80% of U.S. prescription drug claims. All three are currently suing Arkansas over Act 624 of 2025, which would ban PBMs from owning pharmacies in the state. A federal judge has temporarily blocked the law.
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