Dive Brief:

简报：

Arkansas Governor Sarah Huckabee Sanders signed a first-of-its-kind law last week preventing pharmacy benefit managers from owning or operating pharmacies, as states increasingly move to restrict controversial business practices of the powerful drug middlemen.

阿肯色州州长莎拉·哈克比·桑德斯上周签署了一项前所未有的法律，禁止药品福利管理公司拥有或经营药店，因为各州正越来越多地采取行动限制这些强大的药品中间商备受争议的商业行为。

The legislation was decried by PBMs, which say it will impede pharmaceutical access in the state.

该立法遭到药品福利管理公司的谴责，他们表示这将阻碍该州的药品获取。

Yet, other states could follow suit.

然而，其他州也可能效仿。

Bills with similar provisions

具有类似条款的账单

were recently introduced in Vermont, Texas and New York, according to the National Community Pharmacists Association.

根据全国社区药剂师协会的说法，佛蒙特州、德克萨斯州和纽约州最近推出了。

Dive Insight:

深入洞察：

The push among regulators and legislators to lower drug prices in America has recently focused on PBMs, companies that negotiate drug discounts with pharmaceutical manufacturers in return for favorable placement on plans’ formularies and pay pharmacies for dispensing medication.

美国监管机构和立法者近期将降低药品价格的焦点放在了药品福利管理公司（PBMs）上，这些公司与制药商谈判药品折扣，以换取在计划处方集中的有利位置，并向药房支付配药费用。

In particular, legislators have targeted the “Big Three PBMs” operated by healthcare conglomerates CVS, UnitedHealth and Cigna, which jointly control 80% of the U.S. prescription drug market,

特别是，立法者已将目标对准了由医疗集团CVS、联合健康和信诺运营的“三大药品福利管理机构”，它们共同控制着美国80%的处方药市场。

Despite momentum in Congress at the close of last year, PBM reform legislation failed to make it across the finish line, leaving a gap that states appear increasingly willing to step into. Arkansas’ legislation, for one, is meant to prevent a conflict of interest that comes when PBMs own pharmacies that was highlighted by the Federal Trade Commission in .

尽管在去年年底国会有一定的推动势头，但PBM改革立法未能最终通过，留下了各州似乎越来越愿意填补的空缺。例如，阿肯色州的立法旨在防止当PBM拥有药房时产生的利益冲突，这一问题曾被联邦贸易委员会指出。

a pair of damaging

一对损害性的

reports on the PBM industry

关于PBM行业的报告

released late last year and early this year.

去年年底和今年年初发布。

The FTC found the Big Three — CVS’ Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx — generally paid independent pharmacies lower rates than in-house pharmacies, directed business to their owned subsidiaries and

联邦贸易委员会发现，CVS的Caremark、Cigna的Express Scripts和UnitedHealth的Optum Rx这三大巨头通常支付给独立药房的费用低于自家药房，并将业务导向其旗下的子公司。

pressured independent pharmacies

受压的独立药房

to accept coercive and damaging fees.

接受强制性和损害性的费用。

“For far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications. Not anymore,”

“长久以来，药品中间商（PBM）利用宽松的监管滥用了客户，抬高药品价格，并切断了对关键药物的获取。这种现象将不再继续，”

Sanders, a Republican, said in a statement

桑德斯，一名共和党人在一份声明中说

after signing the legislation, named HB1150.

签署名为HB1150的立法后。

However, HB1150 — which goes into effect Jan. 1, 2026 — will hurt patients, PBMs say.

然而，药品福利管理公司表示，HB1150 法案——将于 2026 年 1 月 1 日生效——将损害患者利益。

CVS, which operates a major network of retail pharmacies along with its PBM Caremark, may have to close its 23 pharmacies in the state, disrupting services for hundreds of thousands of customers and costing hundreds of Arkansans their jobs, according to the company.

CVS经营着一个大型零售药店网络，旗下还有药品福利管理公司Caremark。该公司表示，可能不得不关闭其在该州的23家药店，这将中断数十万客户的服务，并导致数百名阿肯色州人失去工作。

The law was driven by “special interest rhetoric that cherrypicked data and ignored inconvenient facts,” a spokesperson for CVS said, noting that the number of independent pharmacies in Arkansas has increased in the last few years.

CVS 的发言人表示，该法律是受到“特殊利益集团的言论驱动，他们挑选数据并忽略不便的事实”，并指出阿肯色州独立药房的数量在过去几年中有所增加。

“CVS Health welcomes a good-faith discussion with policy makers in Arkansas and across the country on ways to make medicine more affordable and accessible. Unfortunately, HB1150 is bad policy that accomplishes just the opposite,” the spokesperson said.

“CVS Health 欢迎与阿肯色州和全美国的政策制定者进行善意的讨论，探讨如何让药品更实惠和更易获得。然而，HB1150 是一项糟糕的政策，其效果恰恰相反，”该发言人表示。

UnitedHealth oversees an extensive pharmacy network with a smaller footprint of retail locations. But its Genoa subsidiary may have to close

UnitedHealth监管着一个广泛的药房网络，零售点的规模较小。但其子公司Genoa可能不得不关闭。

its 11 pharmacies in Arkansas

其在阿肯色州的11家药店

, cutting off in particular integrated mental and behavioral healthcare for patients with conditions like schizophrenia and depression, UnitedHealth CEO Andrew Witty said

尤其是中断了对精神分裂症和抑郁症等患者的精神和行为综合医疗保健，联合健康首席执行官安德鲁·威蒂表示。

during a call with investors last week.

在上周与投资者的通话中。

Arkansas’ law could also impede specialty medicine, home infusions and home delivery services provided by UnitedHealth’s health services division Optum, according to the executive.

据该高管称，阿肯色州的法律还可能阻碍联合健康集团旗下的健康服务部门Optum提供的专科医疗、家庭输液和送货上门服务。

“We’re significantly concerned about this. We’ll work with the state in the regulatory process post-legislation to try to address those populations and maintain access,” Witty said.

“我们对此表示严重关切。我们将在立法后的监管过程中与州政府合作，努力解决这些问题，并保持获取途径，”威蒂说。

Cigna, which owns PBM Express Scripts and specialty pharmacy business Accredo, did not respond to a request for comment on how Arkansas’ law would affect its operations.

拥有PBM快捷药方和专业药房业务Accredo的信诺未回应关于阿肯色州法律将如何影响其运营的评论请求。

Along with the Big Three PBMs, the legislation will also affect other insurers that operate pharmacies like Elevance and Humana, both of which have specialty pharmacy arms.

除了三大药品福利管理公司（PBMs）外，这项立法还将影响其他经营药房的保险公司，例如拥有专业药房部门的Elevance和Humana。

Arkansas law mirrors bipartisan legislation introduced in Congress in December that

阿肯色州法律反映了去年12月国会上提出的两党立法，

would have forced PBMs to sell pharmacy businesses.

将迫使药品福利管理机构出售药店业务。

Experts said at the time that the reform would lessen revenue and market impact of the biggest PBMs and help independent pharmacies but would have unclear impacts on patients.

专家当时表示，这项改革将减少最大型药品福利管理公司 (PBM) 的收入和市场影响，有助于独立药房的发展，但对患者的影响尚不明确。

Legislators in Congress have also floated forcing more transparency

国会中的立法者也提出了强制提高透明度的建议

around PBMs’ business practices and preventing PBMs from spread pricing, a practice wherein PBMs charge insurers a higher price for a drug than what they reimburse to the pharmacy.

围绕药品福利管理公司的商业行为，并防止其进行价格分摊，这是一种药品福利管理公司向保险公司收取高于他们向药房报销的药物费用的做法。

Still, a coalition of 39 state and territory attorneys general

尽管如此，由39位州和领地的总检察长组成的联盟

urged Congress to follow Arkansas’ example

敦促国会效仿阿肯色州的做法

and prevent PBMs from owning pharmacies in a letter sent to House and Senate leadership last week.

上周寄给众议院和参议院领导层的一封信中，阻止药品福利管理公司拥有药房。

“The passage of such a law would foster competition in the marketplace and give consumers more access to pharmaceutical care, more choice as to their healthcare providers, and more affordable prices,” the attorneys general wrote.

“这样的法律的通过将促进市场竞争，使消费者更容易获得药物治疗、对其医疗保健提供者有更多选择，并且价格更加实惠，”总检察长们写道。

Absent congressional legislation,

缺少国会立法，

all 50 states have enacted laws targeting PBMs

所有50个州都已通过针对药品福利管理公司的法律

in an effort to lower prescription drug pricing, according to the National Academy for State Health Policy.

根据国家州卫生政策学院的说法，为了降低处方药价格。

The 186 pieces of legislation include laws forbidding PBMs from stopping pharmacies from telling patients about cheaper drug alternatives or charging pharmacies extra fees, prohibiting PBMs from spread pricing and requiring PBMs to share more information about rebates and fees with the state.

这186项立法包括禁止药品福利管理公司阻止药店告知患者更便宜的药物替代品或向药店收取额外费用的法律，禁止药品福利管理公司进行差价定价，并要求药品福利管理公司与州政府分享更多关于回扣和费用的信息。