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RUTLEDGE v. PHARMACEUTICAL CARE 
MANAGEMENT ASSN. 
Opinion of the Court 

do  they  lead  to  anything  more  than  potential  operational 
inefficiencies.2 
  PCMA  first  claims  that  Act  900  affects  plan  design  by 
mandating a particular pricing methodology for pharmacy 
benefits.  As PCMA reasons, while a plan might prefer that 
PBMs reimburse pharmacies using a MAC list constructed 
with an eye toward containing costs and ensuring predicta-
bility, Act 900 ignores that preference and instead requires 
PBMs to reimburse pharmacies based on acquisition costs.  
But that argument is just a long way of saying that Act 900 
regulates reimbursement rates.  Requiring PBMs to reim-
burse  pharmacies  at  or  above  their  acquisition  costs  does 
not require plans  to provide  any  particular  benefit  to  any 
particular beneficiary in any particular way.  It simply es-
tablishes a floor for the cost of the benefits that plans choose 
to provide.  The plans in Travelers might likewise have pre-
ferred that their insurers reimburse hospital services with-
out paying an additional surcharge, but that did not trans-
form  New  York’s  cost  regulation  into  central  plan 
administration.3 
  Act 900’s appeal procedure likewise does not govern cen-
tral matters of plan administration.  True, plan administra-
tors  must  “comply  with  a  particular  process,  subject  to 
state-specific deadlines, and [Act 900] dictates the substan-
tive  standard  governing  the  resolution  of  [an]  appeal.”  
Brief for Respondent 24.  Moreover, if a pharmacy wins its 
appeal, a plan, depending on the terms of its contract with 
a PBM, may need to recalculate and reprocess how much it 

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2 PCMA does not suggest that Act 900’s enforcement mechanisms over-
lap with “fundamental components of ERISA’s regulation of plan admin-
istration.”  Gobeille v. Liberty Mut. Ins. Co., 577 U. S. 312, 323 (2016). 

3 PCMA also points to Act 900’s requirement that PBMs update their 
MAC  lists  to  reflect  statutorily  mandated  prices.    But  that  obligation 
does not affect plan design for the same reasons.  Moreover, if PBMs were 
not required to update their MAC lists, they would be in constant non-
compliance with Act 900’s cost regulation.