Last updated: 2026-05-23

PBM Regulation by State (2026)

A 50-state reference for the Pharmacy Benefit Manager (PBM) regulatory framework: state licensure / registration requirements for PBMs, spread-pricing rules in Medicaid managed care, the Maximum Allowable Cost (MAC) appeals process for independent pharmacies, pharmacist gag-clause prohibitions and patient price-disclosure protections, copay accumulator rules, and any-willing-pharmacy / patient-choice statutes. Each state page carries a last-verified date and primary-source citations to the state Board of Pharmacy, Department of Insurance, and applicable statutes.

Reference, not legal or medical advice. PBM statutes change. Every claim below traces to a citation on the state page. Confirm against current state Board of Pharmacy and Department of Insurance guidance.

State comparison

Quick scan across the four primary regulatory axes. Click a state for the full reference with citations.

StatePBM licensureMedicaid spread banGag clause prohibitionCopay accumulator ban
Alabama Yes Yes Yes No
Alaska No Yes Yes No
Arizona Yes Yes Yes No
Arkansas Yes Yes Yes Yes
California Yes Yes Yes No
Colorado Yes Yes Yes No
Connecticut Yes Yes Yes Yes
Delaware Yes Yes Yes Yes
Florida Yes Yes Yes No
Georgia Yes Yes Yes Yes
Hawaii No Yes Yes No
Idaho Yes Yes Yes No
Illinois Yes Yes Yes Yes
Indiana Yes Yes Yes No
Iowa Yes Yes Yes No
Kansas Yes Yes Yes No
Kentucky Yes Yes Yes Yes
Louisiana Yes Yes Yes Yes
Maine Yes Yes Yes Yes
Maryland Yes Yes Yes No
Massachusetts Yes Yes Yes No
Michigan Yes Yes Yes No
Minnesota Yes Yes Yes No
Mississippi Yes Yes Yes No
Missouri Yes Yes Yes No
Montana Yes Yes Yes No
Nebraska Yes Yes Yes No
Nevada Yes Yes Yes No
New Hampshire Yes Yes Yes No
New Jersey Yes Yes Yes No
New Mexico Yes Yes Yes Yes
New York Yes Yes Yes Yes
North Carolina Yes Yes Yes Yes
North Dakota Yes Yes Yes No
Ohio Yes Yes Yes Yes
Oklahoma Yes Yes Yes Yes
Oregon Yes Yes Yes No
Pennsylvania Yes Yes Yes No
Rhode Island Yes Yes Yes No
South Carolina Yes Yes Yes No
South Dakota Yes Yes Yes No
Tennessee Yes Yes Yes Yes
Texas Yes Yes Yes Yes
Utah Yes Yes Yes No
Vermont Yes Yes Yes No
Virginia Yes Yes Yes Yes
Washington Yes Yes Yes Yes
West Virginia Yes Yes Yes Yes
Wisconsin Yes Yes Yes No
Wyoming Yes Yes Yes No

All 50 states

ALAlabamaLicensure required · Spread ban AKAlaskaNo licensure · Spread ban AZArizonaLicensure required · Spread ban ARArkansasLicensure required · Spread ban CACaliforniaLicensure required · Spread ban COColoradoLicensure required · Spread ban CTConnecticutLicensure required · Spread ban DEDelawareLicensure required · Spread ban FLFloridaLicensure required · Spread ban GAGeorgiaLicensure required · Spread ban HIHawaiiNo licensure · Spread ban IDIdahoLicensure required · Spread ban ILIllinoisLicensure required · Spread ban INIndianaLicensure required · Spread ban IAIowaLicensure required · Spread ban KSKansasLicensure required · Spread ban KYKentuckyLicensure required · Spread ban LALouisianaLicensure required · Spread ban MEMaineLicensure required · Spread ban MDMarylandLicensure required · Spread ban MAMassachusettsLicensure required · Spread ban MIMichiganLicensure required · Spread ban MNMinnesotaLicensure required · Spread ban MSMississippiLicensure required · Spread ban MOMissouriLicensure required · Spread ban MTMontanaLicensure required · Spread ban NENebraskaLicensure required · Spread ban NVNevadaLicensure required · Spread ban NHNew HampshireLicensure required · Spread ban NJNew JerseyLicensure required · Spread ban NMNew MexicoLicensure required · Spread ban NYNew YorkLicensure required · Spread ban NCNorth CarolinaLicensure required · Spread ban NDNorth DakotaLicensure required · Spread ban OHOhioLicensure required · Spread ban OKOklahomaLicensure required · Spread ban OROregonLicensure required · Spread ban PAPennsylvaniaLicensure required · Spread ban RIRhode IslandLicensure required · Spread ban SCSouth CarolinaLicensure required · Spread ban SDSouth DakotaLicensure required · Spread ban TNTennesseeLicensure required · Spread ban TXTexasLicensure required · Spread ban UTUtahLicensure required · Spread ban VTVermontLicensure required · Spread ban VAVirginiaLicensure required · Spread ban WAWashingtonLicensure required · Spread ban WVWest VirginiaLicensure required · Spread ban WIWisconsinLicensure required · Spread ban WYWyomingLicensure required · Spread ban

Consumer-side: cheapest legal fill in your state

PBM regulation governs how the rules work behind the counter. For the consumer-side question (cheapest legal fill, generic substitution, Medicaid PDL, SPAP eligibility), see our sister site RxGrab's prescription drug law by state reference.