Four governors signed significant PBM reform legislation in recent weeks, with North Carolina, Connecticut, Illinois, and Louisiana enacting comprehensive measures including rebate pass-through requirements, spread pricing prohibitions, and enhanced transparency reporting. However, legal challenges are mounting against state PBM laws. Arkansas faces three lawsuits over its pharmacy ownership ban, Iowa's reform law was temporarily blocked by federal court, and the Supreme Court declined to hear Oklahoma's case, leaving a restrictive appellate ruling in place that could impact future state PBM regulation.

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.