LUGPA Policy Brief:
State Legislative Momentum on PBM Reform in 2025
July 2025
As federal efforts to reform pharmacy benefit managers (PBMs) stall, states are leading initiatives against opaque and anti-competitive practices. In 2024, over 30 PBM-related bills were passed across 20 states, with all 50 states considering similar legislation by mid-2025. This brief highlights key trends in state reforms affecting independent urology practices and LUGPA’s advocacy role.
State Leadership Amid Federal Inaction
While bipartisan consensus on PBM reform exists in Congress, federal actions have been limited to incremental measures. States are stepping up to eliminate anti-competitive behavior, enhance transparency, and protect patient access to medications.
Key State Legislative Trends
- Banning Spread Pricing & Pass-Through Models
- Regulating PBM-Pharmacy Relationships
- Arkansas (HB 1150) and Iowa restrict PBM pharmacy ownership and favoritism towards affiliated pharmacies, supporting independent pharmacies crucial to urology practices.
- Enhancing Licensing and Transparency
- Supporting Independent & Rural Pharmacies
- States like Iowa and Arkansas prioritize minimum reimbursements and rural pharmacy preservation to ensure medication access.
States to Watch in 2025
New York and Massachusetts are setting national precedents with NADAC-based reforms, while Indiana, Texas, Vermont, Missouri, North Dakota, and Utah have enacted or proposed significant PBM reforms.
Legal and Compliance Considerations
A 2020 Supreme Court decision (Rutledge v. PCMA) confirmed that states can regulate PBMs, even for some employer-sponsored (ERISA) health plans. However, ongoing lawsuits—especially in Florida and Arkansas—could affect how these laws are enforced, particularly for practices operating in multiple states.
What This Means for Urology Practices
State reforms can improve drug pricing transparency and pharmacy reimbursement, but may also create confusion due to varying laws and legal uncertainty. LUGPA supports clear, consistent rules that protect independent providers and patient access. We continue to monitor policy changes and help practices navigate the evolving landscape.
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