Leading PBMs face increasing scrutiny from states

Leading PBMs face increasing scrutiny from states
Healthcare Brew; by Nicole Ortiz; 6/18/25
Iowa is the latest to impose limits on how PBMs can operate in the state... It all started when Arkansas Governor Sarah Huckabee Sanders signed a law on April 16 saying any company that owns a pharmacy benefit manager (PBM) would be prohibited from also owning or operating pharmacies in the state. That’s seemingly bad news for the Big 3 PBMs—Cigna Group’s Express Scripts, CVS’s Caremark, and UnitedHealth’s Optum Rx, which collectively control nearly 80% of the market—seeing as they all also operate pharmacy chains. Now the state of Iowa wants to get in on the action, with Governor Kim Reynolds signing a law on June 11 to change how PBMs operate in the state.