Find out what’s happening in Washington D.C. and around the states
Federal legislative update
Washington awaits the Trump administration’s guidance on PBMs
Headed into the fall, we expect the Trump Administration to provide some follow up guidance on the president’s prescription drug Executive Orders that were issued earlier this year. We are closely monitoring the status of the guidance and will share updates as we learn more.
State legislative updates
Work winding down across the country
Since the beginning of 2025, states have introduced more than 900 bills related to pharmacy benefits. Many of these bills aim to limit plan sponsors’ ability to provide quality, affordable prescription drug benefit plan designs, including preferred, home delivery and specialty networks. Many of them also seek to change how plan sponsors may compensate a pharmacy benefit manager for services and may impact rebate savings.
CVS Health continues to focus our advocacy efforts on priority issues like those that may increase costs and reduce flexibility for plan sponsors. We want to preserve your options and make sure you continue to have flexibility to contract pharmacy benefit services and design pharmacy benefit programs that best meet your needs. Our efforts include educating about these complex health care and benefit design issues and connecting policymakers with local employers to help them understand the impact of potential legislation.
Thanks to our advocacy efforts and the support of plan sponsor voices like yours, we were able to defeat many pieces of harmful legislation before final passage.
As of September 9, 2025, eight states (CA, MA, MI, NJ, NC, OH, PA, WI) are in regular legislative session; 42 have adjourned for the year. Alaska is currently in special session on issues not related to the pharmacy benefit; Colorado completed its special session.
In states that are still in session, CVS Health focused on bills of highest priority to a wide variety of plan sponsors, including fully insured, self-funded non-ERISA and self-funded ERISA plans. If legislation passes, actual impacts will depend on final language and how regulators apply and enforce state requirements. We encourage you to seek your own legal counsel to determine business impacts.
California and New Jersey
At the time of writing, both California (SB 41) and New Jersey (A. 4953) were considering legislation with “delinking” provisions that prohibit certain price- and rebate-based compensation structures for how plan sponsors compensate PBMs for the services they provide.
In California, SB 41 passed both chambers of the legislature, and the bill is now with Governor Gavin Newsom. He has until October 13, 2025, to either take action or allow the bill to become law without his signature.
In New Jersey, A. 4953 passed the Assembly and is pending in the Senate. New Jersey has odd-year elections and, given focus on political campaigns, we do not expect substantive policymaking before Election Day on Nov. 4, 2025. However, A. 4953 may be considered during the post-election lame duck period.
These “delinking” provisions would benefit only pharmaceutical manufacturers – to the tune of billions of dollars – and result in increased costs for plan sponsors and patients. The National Bureau of Economic Research estimates that, if applied nationwide, delinking proposals would increase commercial health insurance premium costs up to $26.6 billion and result in $32 billion in profits for drug manufacturers.
Strengthening advocacy with diverse voices
Policymakers need to hear from employers and plan sponsors like you to understand how PBM-focused bills will impact constituents in their states. We encourage you to engage with these proposed laws and we have resources available, including cost-impact estimates, to facilitate engagement opportunities.
Thanks to our advocacy efforts and the support of plan sponsor voices like yours, many pieces of harmful legislation were either defeated or withdrawn before final passage. We estimate our State Government Affairs team helped successfully stop 34 high-priority pharmacy benefit legislative efforts in 18 states this year.
Pharmacy benefit legislation passed in a small number of states, including AL, AR, CO, CT, IN, IA and UT. In many of these states, our advocacy led to reduced or mitigated impacts for plan sponsors in the final passed version. If any new laws have passed that impact your plan, your CVS Health account team will be in touch to guide you through the implementation process.
Legislators across the country want to hear from employers, unions, and other plan sponsors who would see their costs increase under these harmful proposals. Your voice can make a difference in opposing these laws and shaping better policy across the country.
We are actively working to build on this year’s engagement successes and enhance how we communicate with you. Thank you for your continued support and feedback to help us improve and better serve you.
