Pharmaceutical Care Management v. Mylynn Tufte, 968 F.3d 901

PCMA, a national trade association for pharmacy benefits managers (PBMs), sued North Dakota after the state enacted N.D. Cent. Code §§ 19-02.1-16.1 and -16.2 (2017) regulating PBMs, third-party payers, copayments, quality metrics, ownership interests, disclosures, and imposing misdemeanor penalties for violations.
PBMs negotiate drug prices, create pharmacy networks, and process prescription claims for health plans, including ERISA-covered employee benefit plans.
North Dakota’s statutes define “third-party payer” as organizations financing personal health services and adopt ERISA’s definition of “plan sponsor,” bringing ERISA plans within the regulated class.
PCMA sought declaratory and injunctive relief, arguing ERISA and Medicare Part D preempt the legislation; the district court held ERISA did not preempt the statutes but found one provision preempted by Medicare Part D.
On appeal the Eighth Circuit reviewed de novo and held the statutes are preempted by ERISA because they impermissibly reference ERISA plans (by regulating PBMs and entities that administer ERISA-covered benefits), reversed in part, affirmed in part, and remanded with directions to enter judgment for PCMA.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether ERISA preempts ND statutes regulating PBMs/third-party payers	PCMA: statutes reference and apply to ERISA plans (via definitions like "third-party payer" and "plan sponsor"), so they "relate to" ERISA plans and are preempted	North Dakota: statutes cover many non-ERISA entities, so they do not act immediately/exclusively on ERISA plans and are not preempted; Gerhart should be limited	Held: ERISA preempts the statutes in whole; definitions implicitly regulate ERISA plans and thus impermissibly reference ERISA (reversing district court)
Whether Medicare Part D preempts any provision of the statutes	PCMA: Part D preempts state rules that interfere with Part D plan administration	North Dakota: district court largely rejected Part D preemption; ND did not cross-appeal the single Part D preemption finding	Held: District court’s determination that § 19-02.1-16.2(2) is preempted by Medicare Part D stands; appellate court did not disturb that finding and relied on ERISA preemption for broader relief
Whether any provisions survive under ERISA’s savings clause	PCMA: N/A (seeking full preemption)	North Dakota: urged remand to consider which provisions might be saved	Held: Issue waived by North Dakota for failing to brief which provisions should survive; court did not decide savings-clause applicability

Pharm. Care Mgmt. Ass’n v. Gerhart, 852 F.3d 722 (8th Cir. 2017) (statute that implicitly references ERISA plans by regulating PBMs is preempted)
Pharm. Care Mgmt. Ass’n v. Rutledge, 891 F.3d 1109 (8th Cir. 2018) (similar Arkansas statute held preempted for implicitly regulating ERISA plans)
Gobeille v. Liberty Mut. Ins., 136 S. Ct. 936 (2016) (explaining categories for ‘‘reference to’’ ERISA plans)
N.Y. State Conf. of Blue Cross & Blue Shield Plans v. Travelers Ins., 514 U.S. 645 (1995) (ERISA preemption requires limiting principles; introduced "reference to" and "connection with" framework)
Cal. Div. of Labor Standards Enf’t v. Dillingham Constr., 519 U.S. 316 (1997) (discussing limits on ERISA preemption scope)
Metro. Life Ins. Co. v. Massachusetts, 471 U.S. 724 (1985) (even indirect state action affecting private pensions may intrude on federal domain)
Express Scripts, Inc. v. Wenzel, 262 F.3d 829 (8th Cir. 2001) (state laws that indirectly force plan administrators’ decisions can be preempted)