This educational guide is based on the linked primary sources. It is not a Court publication, is not affiliated with the Court, and is not legal advice.
In brief
Overview
According to Leslie Rutledge, Attorney General of Arkansas (Petitioner), according to Leslie Rutledge, Attorney General of Arkansas (Petitioner), pharmacy Benefit Managers (PBMs) act as intermediaries that reimburse pharmacists at rates often below their costs, which can force pharmacies to close and reduce access in rural Arkansas.
According to Mr. Bronni, the state requires PBMs to reallocate part of their margin back to local pharmacies so that independent rural pharmacies can remain in business and communities retain access to pharmacy services.
The petitioner argues that ERISA does not preempt state laws that implement or enforce rate regulation, and that Act 900’s enforcement mechanisms are permissible under Arkansas law.
According to Mr. Waxman, the respondent contends that Act 900 directly compels ERISA plan administrators to follow state‑specific rules, creating a patchwork that makes uniform plan administration impossible.
According to Frederick Liu, amicus brief by the United States frames the central legal question as whether Arkansas law directly regulates a central matter of plan administration, which would be impermissible under ERISA.
According to J.B. Hunt Company, amicus brief by J.B. Hunt emphasizes the difficulty of achieving uniform plan administration across states.
- [1] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [2] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [3] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [4] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [5] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [6] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
Background and question before the Court
Arkansas’s Act 900 seeks to regulate PBM reimbursement rates and requires PBMs to allocate margins back to local pharmacies to preserve access in rural communities.
According to Frederick Liu, the key issue before the Court is whether Act 900 directly regulates a central matter of ERISA plan administration, making it subject to preemption.
What each side argues
Petitioner – Leslie Rutledge, Attorney General of Arkansas
According to Leslie Rutledge, Attorney General of Arkansas (Petitioner), according to Leslie Rutledge, Attorney General of Arkansas (Petitioner), pBMs reimburse pharmacists at rates below cost, threatening pharmacy viability.
ERISA does not preempt laws that implement or enforce rate regulation; Act 900’s enforcement mechanisms are permissible state rate regulation.
According to Mr. Bronni, requiring PBMs to reallocate part of their margin to local pharmacies will keep independent rural pharmacies open and maintain community access to pharmacy services.
Respondent – Pharmaceutical Care Management Association
According to Mr. Waxman, act 900 directly compels ERISA plan administrators to comply with state‑specific rules, creating a patchwork that makes uniform plan administration impossible.
What happened at oral argument
Frederick Liu presented oral argument on behalf of the United States as amicus curiae.
Seth P. Waxman presented oral argument on behalf of the respondent.
Justice Thomas asked whether the copay determination, a central plan function, would be controlled by the plan if the pharmacy won its appeal.
According to Justice Kagan, justice Kagan inquired about the distinction between regulating PBMs and regulating plans, and whether a plan‑managed benefit would raise a different question.
Justice Kavanaugh asked a follow‑up question seeking clarification of the respondent’s position.
According to Justice Gorsuch, justice Gorsuch questioned whether ERISA preemption of the Arkansas law would also preempt other general benefit regulations.
- [1] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [2] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [3] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [4] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [5] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
- [6] 710786024e91cb1d1d4e-r1-699224459d84f531.pdf, pp. 1–61
What the Court decided
Why it matters
Terms to know
No glossary terms are available for this guide.
Primary sources
Read the source materials on the official site or open the immutable repository copy used for this guide.
- 710786024e91cb1d1d4e-r1-699224459d84f531.pdforal argument transcript
Guide generated September 27, 2026. Automated validation accepted this version.