Document ID: ./input/supremecourt_opinions/opinions/20pdf/18-540_m64o.pdf
Page Number: 1.0

(Slip Opinion) 

OCTOBER  TERM,  2020 

1 

Syllabus 

NOTE:  Where  it  is  feasible,  a  syllabus  (headnote)  will  be  released,  as  is 
being  done  in  connection  with  this  case,  at  the  time  the  opinion  is  issued. 
The  syllabus  constitutes  no  part  of  the  opinion  of  the  Court  but  has  been 
prepared  by  the  Reporter  of  Decisions  for  the  convenience  of  the  reader. 
See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337. 

SUPREME COURT OF THE UNITED STATES 

Syllabus 

RUTLEDGE, ATTORNEY GENERAL OF ARKANSAS v. 
PHARMACEUTICAL CARE MANAGEMENT 
ASSOCIATION 

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR 
THE EIGHTH CIRCUIT 

No. 18–540.  Argued October 6, 2020—Decided December 10, 2020 

Pharmacy benefit managers (PBMs) act as intermediaries between phar-
macies and prescription-drug plans.  In that role, they reimburse phar-
macies  for  the  cost  of  drugs  covered  by  prescription-drug  plans.    To 
determine the reimbursement rate for each drug, PBMs develop and 
administer maximum allowable cost (MAC) lists.  In 2015, Arkansas 
passed Act 900, which effectively requires PBMs to reimburse Arkan-
sas  pharmacies  at  a  price  equal  to  or  higher  than  the  pharmacy’s 
wholesale cost.  To accomplish this result, Act 900 requires PBMs to 
timely  update  their  MAC  lists  when  drug  wholesale  prices  increase, 
Ark.  Code  Ann.  §17–92–507(c)(2),  and  to  provide  pharmacies  an  ad-
ministrative appeal procedure to challenge MAC reimbursement rates, 
§17–92–507(c)(4)(A)(i)(b).  Act 900 also permits Arkansas pharmacies 
to refuse to sell a drug if the reimbursement rate is lower than its ac-
quisition cost.  §17–92–507(e).  Respondent Pharmaceutical Care Man-
agement Association (PCMA), which represents the 11 largest PBMs 
in  the  country,  sued,  alleging,  as  relevant  here,  that  Act  900  is  pre-
empted  by  the  Employee  Retirement  Income  Security  Act  of  1974 
(ERISA).    Following  Circuit  precedent  in  a  case  involving  a  similar 
Iowa statute, the District Court held that ERISA pre-empts Act 900.  
The Eighth Circuit affirmed. 

Held: Arkansas’ Act 900 is not pre-empted by ERISA.  Pp. 4–10. 

(a) ERISA pre-empts state laws that “relate to” a covered employee 
benefit plan.  29 U. S. C. §1144(a).  “[A] state law relates to an ERISA 
plan if it has a connection with or reference to such a plan.”  Egelhoff