The Tenth Circuit Court of Appeals ruled that the Employee Retirement Income Security Act of 1974 (ERISA) and Medicare Part D preempt various provisions in Oklahoma’s Patient’s Right to Pharmacy Choice Act (the Act) on August 15, 2023, in Pharmaceutical Care Management Association v. Mulready here.

The Pharmaceutical Care Management Association (PCMA) sued to void the Act, stating that ERISA and Medicare Part D preempted the Act. The United States District Court for the Western District of Oklahoma ruled that ERISA did not preempt the Act. PCMA appealed the district court’s ERISA ruling on four provisions of the Act.

The four provisions deal with retail pharmacy network access standards, discount prohibition, any willing provider provision and prohibition on limitations of probation-based pharmacy providers. Mulready argued that these provisions were not preempted by ERISA.

The Court held that the access standards, discount prohibition and any willing provider provision are preempted by ERISA because they are network restrictions that mandate benefit structures prohibited by ERISA. The Court further states the Act’s requirements for a single-tiered network with uniform copayments, unrestricted specialty-drug access, and complete patient freedom to choose a brick-and-mortar pharmacy are likewise impermissible. These network restrictions are state laws that mandate benefit structures. ERISA forbids this.

While this is a win for self-funded health plans subject to ERISA in that it supports uniform plan administration across state lines it might not be the last word on the subject. 

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