Edited by Trisha Omolon and Sofia Meinardus
Abstract
Pharmacy Benefit Managers (PBMs) were originally intended to lower prescription drug costs for Americans. However, PBMs have evolved into dominant pharmaceutical intermediaries that raise prices through anticompetitive practices. Although states have attempted to regulate PBMs, many of these efforts have been struck down under federal preemption, raising constitutional questions about state sovereignty in public health. This paper argues that the Supreme Court must clarify the limits of federal preemption in healthcare, engaging with the Equal Sovereignty and Anti-Commandeering doctrines. It proposes a viable solution through an adaptable, agency-based regulatory framework—balancing federal supremacy with state authority to restore oversight and preserve the constitutional balance of powers.
