Eighth Circuit grills Iowa on law regulating healthcare middlemen

An Eighth Circuit panel heard Iowa defend Senate File 383, a 2025 law cracking down on pharmacy benefit managers, after a lower court blocked 13 of its provisions. Iowa's deputy solicitor general argued the business and health groups suing to stop the law lack standing since it technically regulates only the middlemen, not the plans themselves.

Judges across the ideological spectrum were unmoved. Judge Loken called Iowa's standing theory a novel result nobody has ever bought, and Judge Arnold rejected Iowa's claim that the ERISA insurance savings clause shields the law, saying it governs relationships between PBMs and providers, not insurance itself.

The plaintiffs, meanwhile, want the whole law tossed, partly because Iowa gave companies just 15 days to comply after the governor signed it. Iowa says without the law, community pharmacies will keep closing; the health plans say squeezing PBMs just squeezes them right back.

The full dispatch is available from the source below.