States enacted significant pharmacy benefit manager reforms in 2025, with Arkansas implementing the nation's first PBM-pharmacy ownership ban despite facing legal challenges. Massachusetts passed comprehensive licensing requirements, while Colorado and California adopted "delinking" laws prohibiting PBM compensation tied to drug prices. Utah mandated rebate pass-through mechanisms. These diverse approaches reflect growing bipartisan momentum toward curbing PBM practices affecting independent pharmacies and drug pricing transparency.

During the 2024 state legislative sessions, 33 bills were enacted in 20 states related to the regulation of pharmacy benefit managers (PBMs). States used a variety of tactics, including spread pricing prohibitions, 340B pharmacies, patient steering and affiliated pharmacies, and mandates for increased reporting of PBM activities.