States Continue to Advance New PBM and Drug Pricing Legislation in 2026

Why It Matters

The measures tighten oversight of PBMs, aiming to lower drug costs for consumers and increase price visibility for insurers, potentially reshaping the national PBM business model. Their success could spur similar legislation in other states, accelerating a fragmented but powerful regulatory wave.

Key Takeaways

• Virginia adopts Inflation Reduction Act fair price ceiling for state plans
• PBMs must disclose rebates, fees, and conflicts to plan sponsors
• Ohio creates dedicated PBM licensure, boosting audit and enforcement powers
• Virginia caps insulin cost‑sharing at $35 per 30‑day supply

Pulse Analysis

State governments are increasingly stepping into the PBM arena as federal action stalls, using legislation to force greater price transparency and curb opaque rebate practices. Virginia’s Affordable Medicine Act leverages the Inflation Reduction Act’s maximum fair price methodology, extending it to state‑run health plans and offering ERISA plans an opt‑in path. By mandating detailed financial reporting from PBMs—including administrative fees and rebate retention—the Commonwealth aims to translate savings directly into lower enrollee cost‑sharing, a model that could become a template for other jurisdictions.

In Virginia, the reforms go beyond pricing caps. The new S.B. 669 bans several abusive PBM tactics, such as electronic claim‑processing fees and retroactive claim reductions, while reinforcing pass‑through pricing and requiring 100% of manufacturer rebates to flow to plans or consumers at the point of sale. Simultaneously, H.B. 1214 reduces insulin and diabetes‑equipment cost‑sharing caps to $35 per 30‑day supply starting in 2027, tightening the financial squeeze on patients and signaling a broader commitment to drug affordability.

Ohio’s HB 229 reshapes the regulatory landscape by moving PBMs out of the third‑party administrator framework into a dedicated licensing structure. The law introduces annual accounting disclosures, contractual transparency and conflict‑of‑interest reporting, while granting the state insurance superintendent ten‑year record‑retention requirements and robust audit powers. With civil penalties of up to $15,000 per violation and cease‑and‑desist authority, Ohio is positioning itself as a testing ground for stricter PBM oversight that could influence national policy debates and encourage other states to adopt similar licensing regimes.