Document ID: ./input/supremecourt_opinions/opinions/20pdf/18-540_m64o.pdf
Page Number: 12

Cite as:  592 U. S. ____ (2020) 

9 

Opinion of the Court 

(and its beneficiary) owes.  But any contract dispute impli-
cating  the  cost  of  a  medical  benefit  would  involve  similar 
demands and could lead to similar results.  Taken to its log-
ical endpoint, PCMA’s argument would pre-empt any suits 
under state  law  that  could  affect  the  price  or provision  of 
benefits.  Yet this Court has held that ERISA does not pre-
empt  “state-law  mechanisms  of  executing 
judgments 
against  ERISA  welfare  benefit  plans,  even  when  those 
mechanisms prevent plan participants from receiving their 
benefits.”    Mackey  v.  Lanier  Collection  Agency  &  Service, 
Inc., 486 U. S. 825, 831–832 (1988). 
  PCMA  also  argues  that  Act  900  interferes  with  central 
matters of plan administration by allowing pharmacies to 
decline to dispense a prescription if the PBM’s reimburse-
ment will  be  less than the  pharmacy’s  cost  of acquisition.  
PCMA contends that such a refusal effectively denies plan 
beneficiaries  their  benefits,  but  that  argument  misunder-
stands  the  statutory  scheme.    Act  900  requires  PBMs  to 
compensate pharmacies at or above their acquisition costs.  
When a pharmacy declines to dispense a prescription, the 
responsibility lies first with the PBM for offering the phar-
macy a below-acquisition reimbursement. 
  Finally, PCMA argues that Act 900’s enforcement mech-
anisms interfere with nationally uniform plan administra-
tion  by  creating  “operational  inefficiencies.”    Brief  for  Re-
spondent 34.  But creating inefficiencies alone is not enough 
to trigger ERISA pre-emption.  See, e.g., Mackey, 486 U. S., 
at  831 (holding that  ERISA  did  not  pre-empt a  state  gar-
nishment  procedure  despite  petitioners’  contention  that 
such actions would impose “substantial administrative bur-
dens and costs” on plans).  PCMA argues that those opera-
tional inefficiencies will lead to increased costs and, poten-
tially, decreased benefits.  ERISA does not pre-empt a state 
law that merely increases costs, however, even if plans de-
cide to limit benefits or charge plan members higher rates 
as a result.  See De Buono, 520 U. S., at 816 (“Any state tax,