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On December 10, 2020, the Supreme Court in Rutledge v. Pharmaceutical Care Management Association held that ERISA does not pre-empt an Arkansas law regulating PBM prescription drug payment rates to pharmacies because it merely functions as a cost regulation it does not forc[e] ERISA plans to adopt any particular scheme of substantial coverage or otherwise impermissibly relate to ERISA plans. As a practical matter, the 8-0 ruling, which surprised many in the industry, likely puts an end to any serious ERISA pre-emption challenges to similar laws adopted in more than 35 states. More importantly, the ruling may give more leeway to states seeking to expand regulation of prescription drug and other health care reimbursement rates, even if those efforts might lead to increases in health plan costs or reductions in plan benefits.