PBM Trade Group Files Second State Lawsuit in One Week

The Pharmaceutical Care Management Association (PCMA), the primary trade group representing pharmacy benefit managers (PBMs), filed a lawsuit seeking to exempt PBMs from Illinois's Prescription Drug Affordability Act, according to Healthcare Dive. The filing, reported June 18, 2026, marks the second major legal challenge PCMA has launched against a state PBM reform law within a single week — a sign of escalating tension between the PBM industry and state legislatures pushing to rein in drug pricing intermediaries.

PBMs sit between drug manufacturers, insurers, and pharmacies. They negotiate drug prices, manage formularies, and process prescription claims on behalf of health plans — including Medicare Part D plans and Medicare Advantage plans that include drug coverage. Because of their central role, PBM business practices have increasingly drawn scrutiny from state and federal lawmakers concerned about prescription drug affordability.

What the Illinois Law Would Do — and Why PCMA Objects

Illinois's Prescription Drug Affordability Act is one of a growing number of state laws designed to increase transparency and impose new requirements on PBMs. The specific provisions PCMA is challenging were not detailed in the source summary, but state PBM reform laws typically address practices such as spread pricing (where a PBM charges a health plan more for a drug than it pays the pharmacy and keeps the difference), clawbacks on pharmacist reimbursements, and formulary management rules.

PCMA's lawsuit argues, as it has in similar cases in other states, that such state laws are preempted by federal law — particularly the Employee Retirement Income Security Act (ERISA), which governs employer-sponsored benefit plans, or in the Medicare context, federal statutes that set the rules for Part D plan administration. The legal theory, in essence, is that states cannot layer requirements on top of federal drug benefit rules.

Courts have reached mixed conclusions in similar cases. Some state PBM laws have survived legal challenges; others have been blocked. The Illinois case will likely take months or years to resolve, and an injunction could pause the law's enforcement in the meantime.

Why Medicare Beneficiaries Should Pay Attention

For people on Medicare, PBMs are largely invisible — but they shape two of the most important aspects of drug coverage: which medications are covered and what enrollees pay for them. Every Medicare Part D stand-alone drug plan and every Medicare Advantage Prescription Drug (MA-PD) plan uses a PBM to administer benefits. The PBM determines which drugs appear on the formulary at which cost-sharing tier, which pharmacies are considered preferred, and how rebates from drug manufacturers are structured.

State PBM reforms have generally aimed to make those arrangements more transparent or more favorable to consumers and independent pharmacies. If PCMA succeeds in blocking the Illinois law — and similar laws in other states — the practical effect could be that state-level consumer protections for drug pricing do not apply to federally regulated plans, including Medicare. Federal reforms to PBM practices remain in progress at the Centers for Medicare & Medicaid Services (CMS) and in Congress, but the pace and scope of those changes are uncertain.

The broader pattern is worth noting: PCMA's back-to-back lawsuits in the same week suggest the industry is mounting a coordinated legal strategy against state reform efforts. Enrollees in Medicare Part D or Medicare Advantage plans may not feel immediate effects, but the outcome of these cases could influence how PBMs operate — and what plans cost — in future years.

Key Takeaway for Medicare Enrollees

PBM legal battles won't change your 2026 Medicare drug coverage, but they could affect future plan options and drug costs. During Medicare's Annual Enrollment Period (October 15 – December 7), compare Part D and Medicare Advantage plan formularies carefully — drug coverage and cost-sharing can vary significantly between plans even when premiums look similar. A licensed Medicare insurance agent can help you evaluate total drug costs, not just monthly premiums.

What to Watch Going Forward

Several factors make this litigation worth tracking over the coming months. First, the outcome in Illinois — particularly whether a court grants PCMA a preliminary injunction to pause the law while litigation proceeds — will signal how viable state PBM reform laws are in the current legal environment. Second, CMS has been actively updating Part D rules in recent years, and federal regulatory action could either complement or preempt state efforts depending on how rules are written. Third, Congress has periodically revisited PBM transparency requirements, and legislative activity at the federal level could shift the underlying legal landscape that determines whether state laws are preempted.

For now, Medicare beneficiaries are not facing immediate changes to their drug coverage as a result of this lawsuit. But the ongoing debate over PBM practices is part of a larger conversation about prescription drug affordability that directly affects what seniors pay at the pharmacy. Staying informed — and reviewing plan options annually during open enrollment — remains the most practical step enrollees can take.