Arkansas was the test case for whether a state can regulate what PBMs pay pharmacies at all. Act 900 amended Ark. Code Ann. § 17-92-507 to require PBMs to update their maximum allowable cost (MAC) lists, to provide an appeals process, and — critically — barred them from reimbursing a pharmacy below its acquisition cost, defined as the wholesaler invoice price. A pharmacy may decline to dispense at a loss.
The appeal window
Under the statute, a pharmacy has no less than 7 business days to file a MAC appeal, and the PBM must respond within 7 business days. If the appeal is upheld, the PBM must adjust the MAC and allow the pharmacy to reverse and re-bill the claim. (A separate, later Arkansas track — the PBM Licensure Act and its rules — carries different timelines; those do not change Act 900’s 7-business-day window.)
Scope
Act 900 applies to PBMs in the commercial market, including ERISA plans (the point Rutledge settled). It does not apply to MAC lists maintained directly by the Arkansas Medicaid Program or the state Employee Benefits Division — unless they engage a PBM to maintain the list.
In Rutledge v. PCMA (2020) the Supreme Court ruled 8–0 that ERISA does not preempt Act 900 — the decision that opened the door to the state reimbursement laws tracked across this site.