National Community Pharmacy Association – Online Article –  October 9, 2025

Independent Pharmacies Support Iowa PBM Regulations – The fight over pharmacy benefit manager (PBM) regulations has intensified in Iowa, where independent pharmacy groups are backing the state’s efforts to rein in PBM practices. In a recent filing, several leading pharmacy organizations urged federal courts to uphold Iowa’s PBM law, which has been challenged by business and insurance groups.

The Legal Battle Over PBM Oversight

The National Community Pharmacists Association (NCPA), the Iowa Pharmacy Association, the American Pharmacists Association, and the Independent Pharmacy Cooperative filed an amicus brief in federal court. Together, they asked the court to reject a legal challenge that seeks to block Iowa’s law regulating PBMs.

Currently, a lower district court has issued an injunction, preventing Iowa from enforcing the PBM law. Employer and insurance groups argue that the state’s regulations are preempted by the federal Employee Retirement Income Security Act of 1974 (ERISA), which governs employee benefits plans.

Why Independent Pharmacies Disagree

Independent pharmacy groups strongly reject that argument. They emphasize that PBMs are not employee benefits plans. Instead, PBMs act as third-party administrators hired by benefit plans to manage prescription drug coverage. As such, PBMs can—and should—be subject to state regulation.

Their brief makes the point clearly:

“ERISA does not regulate the business practices of third-party providers that, like PBMs, sell goods and services to ERISA plans. Otherwise, ERISA would displace state laws regulating everything from doctors, accountants and lawyers, to hospitals and insurers.”

In short, they argue that regulating PBMs is no different than regulating other healthcare entities or professional services that interact with ERISA plans.

Why This Matters for Independent Pharmacies

Independent pharmacies nationwide have raised alarms about unfair PBM practices, including:

• Below-cost reimbursements that threaten pharmacy survival

• Anti-competitive steering to PBM-owned mail-order pharmacies

• Opaque rebate systems that inflate costs for patients and payors

Pharmacy advocates say that PBMs are driving local pharmacies out of business and reducing patient access to care. State-level reforms, like Iowa’s, aim to increase transparency, fairness, and accountability in the prescription drug supply chain.

The Bigger Picture for Patients and Providers

For patients, especially injured workers, PBM manipulation can mean delayed medications, higher out-of-pocket costs, and fewer pharmacy options. For independent providers, it often means being pushed to the brink of closure.

At RescueMeds, we believe reforms like Iowa’s are critical. By holding PBMs accountable, states can protect independent pharmacies, preserve patient choice, and ensure timely access to medications. Without reform, patients will continue to face barriers created by middlemen prioritizing profit over care.

The Road Ahead

The outcome of this legal challenge could set an important precedent. If the courts uphold Iowa’s PBM law, it will strengthen the ability of states across the country to regulate PBMs and protect patient access to care.

RescueMeds stands with independent pharmacies, patient advocates, and healthcare leaders who are pushing for fairness and transparency in the PBM industry. Because no worker, no patient, and no family should lose access to essential care because of unchecked corporate power.