Throughout 2025, states have ramped up their efforts to regulate Pharmacy Benefit Managers (“PBMs”), taking legislative and legal action to curb predatory practices that have long disadvantaged independent pharmacies. These actions signal a growing recognition of PBMs’ outsized influence in the prescription drug marketplace and the negative impact on pharmacies struggling to compete on an uneven playing field.
Tennessee’s Enforcement Action Against PBM Reimbursement Inequities
One of the most notable developments comes from Tennessee, where the Department of Commerce and Insurance initiated enforcement after identifying multiple violations by a major PBM. In April 2025, the Department found that the PBM had:
- Reimbursed its own affiliated pharmacies at higher rates than unaffiliated independent pharmacies for the same services, directly violating Tennessee state law.
- Failed to properly reimburse independent pharmacies for valid claims.
- Disregarded state audit and appeals protections, including required procedures intended to give independent pharmacies a fair opportunity to contest PBM audit findings.
This action effectively placed the PBM in the same position independent pharmacies often find themselves – defending against audit discrepancies and opaque reimbursement practices.
What This Development Means for Independent Pharmacies
Tennessee’s enforcement, together with similar legislative efforts, such as Arkansas’s Act 624, are hopefully indicative of a new push to limit and prohibit the predatory practices that harm independent pharmacies. Although some of these laws continue to face legal challenges, they represent meaningful progress in balancing the pharmacy marketplace.
In the fight against PBMs, it is important for pharmacy owners to be aware of and utilize all the regulatory and legal tools available. Staying informed can help pharmacies:
- Challenge unfair audits and reimbursement practices
- Take advantage of new state protections as they emerge
- Position themselves for compliance and growth in a shifting regulatory environment
Staying informed is crucial as regulatory environments shift and new enforcement avenues become available.
How Frier Levitt Can Help
Frier Levitt closely monitors evolving PBM regulations across the country to help pharmacies protect their rights and maximize available legal remedies. Our attorneys have deep experience advocating for independent pharmacies against PBM misconduct.
If your pharmacy operates in Tennessee, Arkansas, or any other state implementing new PBM regulations, contact Frier Levitt to understand how these laws may impact your business and how we can help you navigate them.
