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RUTLEDGE v. PHARMACEUTICAL CARE 
MANAGEMENT ASSN. 
Syllabus 

v. Egelhoff, 532 U. S. 141, 147.  Act 900 has neither of those impermis-
sible relationships.  Pp. 4–7. 

(1) Act  900  does  not  have  an  impermissible  connection  with  an 
ERISA  plan.    To  determine  whether  such  a  connection  exists,  this 
Court  asks  whether  the  state  law  “governs  a  central  matter  of  plan 
administration or interferes with nationally uniform plan administra-
tion.”  Gobeille v. Liberty Mut. Ins. Co., 577 U. S. 312, 320.  State rate 
regulations  that merely  increase  costs or  alter  incentives  for  ERISA 
plans without forcing plans to adopt any particular scheme of substan-
tive coverage are not pre-empted by ERISA.  See New York State Con-
ference  of  Blue  Cross  &  Blue  Shield  Plans  v.  Travelers  Ins.  Co.,  514 
U. S. 645, 668.  Like the law at issue in Travelers, Act 900 is merely a 
form of cost regulation that does not dictate plan choices.  Pp. 4–6. 

(2) Act 900 also does not “refer to” ERISA.  It does not “ ‘ac[t] im-
mediately and exclusively upon ERISA plans,’ ” and “ ‘the existence of 
ERISA plans is [not] essential to the law’s operation.’ ”  Gobeille, 577 
U.  S.,  at  319–320.    Act  900  affects  plans  only  insofar  as  PBMs  may 
pass along higher pharmacy rates to plans with which they contract, 
and Act 900 regulates PBMs whether or not the plans they service fall 
within ERISA’s coverage.  ERISA plans are therefore also not essential 
to Act 900’s operation.  Pp. 6–7. 

(b) PCMA’s contention that Act 900 has an impermissible connection 
with an ERISA plan because its enforcement mechanisms both directly 
affect  central  matters  of  plan  administration  and  interfere  with  na-
tionally uniform plan administration is unconvincing.  First, its claim 
that  Act  900  affects  plan  design  by  mandating  a  particular  pricing 
methodology for pharmacy benefits is simply a long way of saying that 
Act 900 regulates reimbursement rates.  Second, Act 900’s appeal pro-
cedure does not govern central matters of plan administration simply 
because it requires administrators to comply with a particular process 
and may require a plan to reprocess how much it owes a PBM.  Taken 
to  its  logical  endpoint,  PCMA’s  argument  would  pre-empt  any  suits 
under state law that could affect the price or provision of benefits, but 
this Court has held that ERISA does not pre-empt “state-law mecha-
nisms of executing judgments against” ERISA plans, Mackey v. Lanier 
Collection Agency & Service, Inc., 486 U. S. 825, 831.  Third, allowing 
pharmacies  to  decline  to  dispense  a  prescription  if  the  PBM’s  reim-
bursement will be less than the pharmacy’s cost of acquisition does not 
interfere with central matters of plan administration.  The responsi-
bility  for  offering  the  pharmacy  a  below-acquisition  reimbursement 
lies  first  with  the  PBM.    Finally,  any  “operational  inefficiencies” 
caused by Act 900 are insufficient to trigger ERISA pre-emption, even 
if  they  cause  plans  to  limit  benefits  or  charge  plan  members  higher 
rates.    See  De  Buono  v.  NYSA–ILA  Medical  and  Clinical  Services