Legislators in at least 12 U.S. states passed laws in 2026 to limit compensation to pharmacy benefit managers, set minimum payments from pharmacy benefit managers to pharmacists, and require pharmacy benefit managers to disclose more information to clients, states, and the public. These legislative actions generated legal challenges and advertising campaigns from entities including CVS Health Corp.

Lawmakers in at least 26 U.S. states introduced more than 120 bills concerning pharmacy benefit managers in 2026. Approximately one quarter of these bills cleared at least one legislative chamber. Some U.S. states now require pharmacy benefit managers to pass along all discounts negotiated with drug manufacturers.

A new Kansas law requires pharmacy benefit managers to pay a $10.50 dispensing fee per prescription, and a new Louisiana law imposes an $11.81 dispensing fee on them. A Tennessee law, effective July 1, 2028, bars pharmacy benefit managers from operating retail pharmacies. CVS Health Corp. filed a federal lawsuit to prevent the closure of its 136 pharmacies in Tennessee under this new state law.

Drug companies, pharmacy benefit managers, and their allies spent at least $24 million on broadcast and digital advertising opposing such regulations from the start of 2025 through mid-2026. CVS spent $4 million in 2026 on advertisements specifically opposing Tennessee's new law related to pharmacy benefit managers. CVS had previously sued Arkansas after that state enacted legislation regulating pharmacy benefit managers, and a federal judge blocked the law.

CVS also settled three lawsuits with Louisiana, in which the state accused the company of unfair trade and deceptive practices in lobbying against legislation. CVS agreed to pay $45 million without acknowledging wrongdoing in those settlements. CVS operates 9,000 pharmacies nationwide. Prem Shaw, President of the CVS Health group overseeing pharmacy and PBM operations, stated in a podcast interview, "If PBMs already didn't exist, you'd need to invent one." Shaw also commented, "Blaming PBMs for high drug prices is like blaming umbrellas for the rain."

Concerns about prescription affordability were reported by about 6 in 10 U.S. adults in a KFF poll conducted earlier in 2026. About 4 in 10 U.S. adults reported in the same poll that medication costs caused them not to take medications as prescribed within the previous year. Generic drugs account for 90% of U.S. prescriptions.

Why It Matters

The legislative efforts in multiple U.S. states to regulate pharmacy benefit managers represent an attempt to influence prescription drug costs and accessibility. These actions aim to increase transparency in drug pricing and ensure minimum payments to pharmacists. The legal challenges and advertising campaigns initiated by companies like CVS Health Corp. indicate an industry response to these regulatory changes, as these changes may affect established business practices.

Public concern regarding medication affordability, as indicated by recent polling data, provides a context for these legislative developments. The judicial actions, such as the federal lawsuit filed by CVS in Tennessee and the blocked Arkansas law, along with the settlements in Louisiana, illustrate the ongoing legal and financial disputes surrounding these regulations.