State and Federal PBM-Pharmacy Ownership Bans Could Reshape Medicaid Managed Care Pharmacy Networks

Avalere analyzes emerging state and federal legislation that would restrict or ban PBM ownership of pharmacies, following Arkansas's pioneering but contested prohibition. For Medicaid MCOs—which contract with PBMs for pharmacy benefits and must ensure adequate network access—these reforms could force restructuring of pharmacy relationships, potentially affecting network adequacy, pharmacy reimbursement models, and the vertical integration strategies that many health plans have pursued to control pharmacy costs.

Pharmacy · Managed Care

This is outside commentary from Avalere, not part of Medicaid Monitor's independently scored news coverage.

More from Avalere