Central States SE & SW Areas Health & Welfare Fund v. Alan McClain
CourtCourt of Appeals for the Seventh Circuit
Date FiledAugust 26, 2026
Docket25-2727
JudgeKolar
StatusPublished
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Full Opinion
In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 25-2727
CENTRAL STATES, SOUTHEAST AND SOUTHWEST AREAS HEALTH
AND WELFARE FUND and CHARLES A. WHOBREY,
Plaintiffs-Appellants,
v.
ALAN MCCLAIN, in his official capacity as Insurance Commis-
sioner of Arkansas, 1
Defendant-Appellee.
____________________
Appeal from the United States District Court for the
Northern District of Illinois, Eastern Division.
No. 1:25-cv-03938 — Jeremy C. Daniel, Judge.
____________________
ARGUED APRIL 14, 2026 — DECIDED AUGUST 26, 2026
____________________
Before HAMILTON, KIRSCH, and KOLAR, Circuit Judges.
KOLAR, Circuit Judge. Arkansas Insurance Department
Rule 128 protects pharmacies operating in Arkansas from
1 We omit the Arkansas Insurance Department from the caption be-
cause Plaintiffs do not appeal the district court’s dismissal of the Depart-
ment under sovereign immunity.
2 No. 25-2727
being paid below “fair and reasonable” rates for dispensing
medications. It imposes two requirements on health plans op-
erating in Arkansas that are relevant to this action. First, it au-
thorizes the Insurance Commissioner of Arkansas to require
that health plans pay additional “dispensing fees” to pharma-
cies (the “Dispensing Fee Requirement”). Second, it requires
plans to report certain information related to their compensa-
tion of pharmacies (the “Reporting Requirements”).
Plaintiffs Central States, Southeast and Southwest Areas
Health and Welfare Fund and its trustee, Charles A. Whobrey
(collectively “the Fund”), represent a self-funded, multiem-
ployer welfare benefit fund that provides health care benefits
to approximately 500,000 participants nationwide, including
in Arkansas. The Fund falls under the ambit of Rule 128 and,
crucial to this action, the Employee Retirement Income Secu-
rity Act of 1974 (ERISA).
The Fund argues that ERISA preempts Rule 128. Specifi-
cally, it argues that both components of the Rule—the Dis-
pensing Fee Requirement and the Reporting Requirement—
bear an impermissible connection to ERISA plans by dictating
plan choices and encroaching on the uniform reporting re-
gime that Congress intended ERISA to provide.
The Fund’s two-part challenge to Rule 128 requires a
straightforward application of one Supreme Court precedent,
and a careful analysis of another. First, under the Supreme
Court’s decision in Rutledge v. Pharmaceutical Care Management
Association, 592 U.S. 80 (2020), we hold that Rule 128’s Dis-
pensing Fee is a “cost regulation” that ERISA does not
preempt.
No. 25-2727 3
The Reporting Requirement presents a closer case. In Go-
beille v. Liberty Mutual Insurance Co., the Court held that a state
law drew an impermissible connection to ERISA by “com-
pel[ling] plans to report detailed information about claims
and plan members,” which “intrude[d] upon a central matter
of plan administration and interfere[d] with nationally uni-
form plan administration.” 577 U.S. 312, 323 (2016) (cleaned
up). Rule 128’s Reporting Requirement is in tension with Go-
beille’s broad determination that “reporting is a principal and
essential feature of ERISA … [and] Congress intended to pre-
empt state reporting laws.” Id. at 325. But given the Fund’s
allegations here, the Reporting Requirement fits within Go-
beille’s exception for “state law[s] … the enforcement of which
necessitates incidental reporting by ERISA plans.” Id. at 325.
We affirm the district court’s dismissal under Federal Rule
of Civil Procedure 12(b)(6).
I. Background
On a motion to dismiss under Rule 12(b)(6), we accept the
facts alleged in the complaint as true and draw all inferences
in favor of the Fund. Ruiz v. Pritzker, 162 F.4th 886, 889 (7th
Cir. 2025). “But written exhibits attached to the complaint,”
like Rule 128 here, “may trump contradictory allegations.”
Squires-Cannon v. Forest Preserve District of Cook County, 897
F.3d 797, 802 (7th Cir. 2018).
The Fund’s quarrel with Rule 128 takes place against the
backdrop of Arkansas’s continued effort to regulate phar-
macy benefit managers, or “PBMs.” PBMs “are a little-known
but important part of the process by which many Americans
get their prescription drugs.” Rutledge, 592 U.S. at 83. Health
plans like the Fund use PBMs as middlemen in securing
4 No. 25-2727
pharmacy benefits: PBMs negotiate with pharmacies to create
“preferred pharmacy networks,” wherein plan participants
can get drugs at a lower cost.
The benefits of PBMs for plans like the Fund are obvious:
they can obtain discounted rates for pharmacy services, as
well as offload certain administrative services like claims pro-
cessing and payment disbursement to the PBMs. But for indi-
vidual pharmacies, PBMs create a barrier to profitability.
Pharmacies are compensated in two ways for dispensing
drugs: First, they are reimbursed for the cost of the drug itself
(the reimbursement rate) and, second, they are paid a fee for
dispensing a specific drug to a specific customer (the dispens-
ing fee). Because just a few PBMs control nearly 85% of the
national market, and operate pharmacies themselves, PBMs
can marshal their market power and the efficiencies of vertical
integration to drive down the reimbursement rates for non-
PBM-owned pharmacies below the wholesale price of drugs.
See Pharmaceutical Care Management Association v. Mulready, 78
F.4th 1183, 1188–90 (10th Cir. 2023).
Arkansas, among other states, has taken steps to regulate
PBMs and ensure an adequate network of pharmacies. First,
in 2015, the state passed Arkansas Code § 17–92–507(c)(2)
(“Act 900”), which “[i]n effect … require[d] PBMs to reim-
burse Arkansas pharmacies at a price equal to or higher than
that which the pharmacy paid to buy the drug from a whole-
saler.” Rutledge, 592 U.S. at 84. The Supreme Court held in
2020 that ERISA did not preempt Act 900. Id.
In September 2024, Arkansas went a step further and
passed a “temporary emergency rule” aimed at ensuring that
reimbursements for pharmacy services (i.e. dispensing fees
No. 25-2727 5
and reimbursements for the cost of the drug) paid by PBMs to
pharmacies were “fair and reasonable.”
That rule, later restyled as “Rule 128” and issued by the
Insurance Commissioner of Arkansas, has two components
relevant to this appeal. First, the rule contains a “Dispensing
Fee Requirement,” authorizing the Commissioner to require
a plan to pay an additional fee to a pharmacy if he determines
a plan’s payment program is not “fair and reasonable.” Sec-
ond, and to enable the Commissioner to make this determina-
tion, “the Reporting Requirement” mandates that all health
benefit plans submit compensation information to the Com-
missioner.
Pursuant to his authority under Rule 128, the Commis-
sioner issued AID Bulletin #18-2024. The Bulletin specified the
precise information health plans must report, including infor-
mation about the total average percentage of pharmacy reim-
bursement above or relative to Medicaid pricing, average dis-
pensing fees paid to pharmacies, the number of drug reim-
bursement claims paid in the prior calendar year, and “other
data related to cost impact.”
Soon after Rule 128 came into effect, the Fund sued the
Commissioner, Alan McClain, in his official capacity, seeking
a declaratory judgment that Rule 128 is preempted by ERISA.
The district court granted McClain’s motion to dismiss under
Rule 12(b)(6). It held that, under Rutledge, the Dispensing Fee
Requirement was a mere “cost regulation” that did not im-
pose a specific plan of substantive coverage on the Fund. And
it concluded that Rule 128’s Reporting Requirements were
merely “incidental” requirements that did not intrude on a
core matter of plan administration. The Fund appealed.
6 No. 25-2727
II. Discussion
To survive a motion to dismiss under Rule 12(b)(6), the
Fund must “state a claim to relief that is plausible on its face.”
Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). We re-
view the district court’s order granting McClain’s motion to
dismiss under Rule 12(b)(6) de novo. Chaidez v. Ford Motor Co.,
937 F.3d 998, 1004 (7th Cir. 2019).
ERISA embodies Congress’s intent “to provide a uniform
regulatory regime over employee benefit plans” and “to en-
sure that employee benefit plan regulation would be ‘exclu-
sively a federal concern.’” Aetna Health Inc. v. Davila, 542 U.S.
200, 208 (2004) (citation omitted). ERISA contains an explicit
preemption clause, providing that it “shall supersede any and
all State laws insofar as they may now or hereafter relate to
any employee benefit plan.” 29 U.S.C. § 1144(a).
The Supreme Court has identified two categories of state
laws that ERISA preempts. See Gobeille, 577 U.S. at 319. “Ref-
erence to” preemption applies “[w]here a State’s law acts im-
mediately and exclusively upon ERISA plans” or “where the
existence of ERISA plans is essential to the law’s operation.”
Id. at 319–20 (quoting California Division of Labor Standards En-
forcement v. Dillingham Construction, N.A., Inc., 519 U.S. 316,
325 (1997)). The Fund has abandoned its “reference to” theory
on appeal, so we need not address it. “Impermissible connec-
tion” preemption applies where a state law “governs ... a cen-
tral matter of plan administration or interferes with nationally
uniform plan administration.” Id. at 320 (quoting Egelhoff v.
Egelhoff, 532 U.S. 141, 148 (2001)) (cleaned up).
The Fund argues that Rule 128’s Dispensing Fee Require-
ment and Reporting Requirement each bear, for different
No. 25-2727 7
reasons, an impermissible connection to ERISA plans. We
conclude that neither requirement infringes on “a central mat-
ter of plan administration” or “nationally uniform plan ad-
ministration.” Id. at 323.
A. The Dispensing Fee Requirement
The Fund argues that Rule 128’s Dispensing Fee Require-
ment bears an “impermissible connection” to ERISA plans.
But because the Fund fails to distinguish the requirement
from a “cost regulation” permissible under Rutledge, we con-
clude that ERISA does not preempt it.
Rutledge involved another Arkansas statute, Act 900,
which regulated the price at which PBMs reimbursed phar-
macies for the cost of drugs. 592 U.S. at 83. The act had three
key provisions: (1) it required PBMs to timely update their re-
imbursement rates in response to increases in drug wholesale
prices; (2) it required PBMs to create procedures for pharma-
cies to appeal the reimbursement prices for drugs that fell be-
low the acquisition cost of the drug; and (3) it permitted phar-
macies to decline to sell a drug to a beneficiary if the PBM’s
reimbursement rate was below the acquisition cost. Id. at 84–
85. An organization representing the largest PBMs in the
country challenged the act as preempted by ERISA, arguing
that the act bore an impermissible connection to ERISA plans.
Id. 2
The Court rejected the challenge. It recognized that Act
900, by increasing costs for PBMs in Arkansas, would create
disuniformity between ERISA plans: “PBMs may well pass
2 The organization in Rutledge brought both an “impermissible con-
nection” and a “reference to” preemption challenge. See 592 U.S. at 85–86.
This opinion discusses only the former.
8 No. 25-2727
those increased costs on to plans, meaning that ERISA plans
may pay more for prescription-drug benefits in Arkansas
than in, say, Arizona.” Id. at 88. But it also observed that “not
every state law that affects an ERISA plan or causes some dis-
uniformity in plan administration has an impermissible con-
nection with an ERISA plan.” Id. at 87. Cost uniformity was
not an object of ERISA, so “ERISA does not pre-empt state rate
regulations that merely increase costs or alter incentives for
ERISA plans without forcing plans to adopt any particular
scheme of substantive coverage.” Id. at 88. Because Act 900
was “merely a form of cost regulation” that did not “bind plan
administrators to any particular choice,” ERISA did not
preempt it. Id. at 87–88.
We apply the same analysis to the Dispensing Fee Re-
quirement. Here, the Fund has not alleged that the Dispens-
ing Fee Requirement does anything more than increase the
cost of pharmacy benefits to the Fund at the Commissioner’s
discretion. Instead, the Fund relies on three decisions by our
colleagues in other circuits that distinguished Rutledge and
found other state regulations of PBMs preempted by ERISA.
See Mulready, 78 F.4th at 1190; McKee Foods Corp. v. BFP Inc.,
173 F.4th 242, 263 (6th Cir. 2026); Flowers v. Caremark PCS
Health, LLC, 180 F.4th 1084, 1089–90 (8th Cir. 2026). We find
all three cases readily distinguishable from this one. Unlike
Rule 128’s Dispensing Fee Requirement, the laws at issue in
each case went far beyond mere cost regulation.
In Mulready, the Oklahoma statute at issue regulated how
PBMs structured their preferred pharmacy networks. See 78
F.4th at 1196–97. The Tenth Circuit held that these network
requirements “d[id] more than increase costs” and “im-
pede[d] PBMs from offering [ERISA] plans some of the most
No. 25-2727 9
fundamental network designs, such as preferred pharmacies,
mail-order pharmacies, and specialty pharmacies.” Id. at 1200.
In McKee, the Tennessee laws at issue required PBMs to
admit all pharmacies into their preferred pharmacy networks.
173 F.4th at 264. These regulations had nothing to do with cost
and “mandate[d] a specific benefit structure by eliminating
the option for plans to set up a limited pharmacy network.”
Id. a 265. The laws further contained “incentive provisions”
impeding PBMs from using financial incentives to steer ben-
eficiaries towards “certain pharmacies with higher or lower
cost-sharing arrangements.” Id. at 268. These provisions were
“more than mere cost regulations like the Court approved in
Rutledge” because they “impose[d] across-the-board, univer-
sal copays and other fees at every pharmacy in a given net-
work.” Id.
And in Flowers, the Arkansas law at issue contained “Ge-
ographic Coverage Requirements” that required PBMs “to
ensure that certain minimum percentages of plan members
live within specified distances of an in-network, retail com-
munity pharmacy.” 180 F.4th at 1088. Again, these regulations
had little to do with regulating cost. But they “forc[ed] [a] par-
ticular scheme of substantive coverage” by “requiring PBMs
to tailor and retailor their networks—and perhaps even build
new brick-and-mortar pharmacies—to comply with a set of
exacting particularities.” Id. at 1090 (cleaned up).
Rule 128 has no such restrictions on how PBMs can struc-
ture their networks, offer discounts, or designate preferred
pharmacy networks. Instead, the Dispensing Fee Require-
ment “regulates” only in the manner the Supreme Court
blessed in Rutledge: cost. True, even a law that only regulates
cost may bear an impermissible connection if its economic
10 No. 25-2727
effects are “so acute that it will effectively dictate plan
choices.” Rutledge, 592 U.S. at 88. But the Fund has made no
allegations suggesting that the Dispensing Fee Requirement
has such an “acute” economic effect.
Alternatively, the Fund points to the Dispensing Fee Re-
quirement’s stipulation that health plans “may not require a
subscriber to pay for the dispensing cost outside of the
amounts the health benefit plan has designated as the co-pay,
co-insurance and deductible.” In the Fund’s view, this effec-
tively dictates plan choices by limiting health plans’ ability to
share costs with plan participants. But the Fund overstates
this limitation. As the district court observed, Rule 128 does
not prevent the Fund from passing on costs to plan partici-
pants. It only specifies how the Fund passes through those
costs: through increased co-pays, co-insurance, or deducti-
bles. How costs are spread—whether as an increased co-pay
or a line-item fee—is not a “particular scheme of substantive
coverage.” Id.
B. The Reporting Requirement
The Fund also argues that Rule 128’s Reporting Require-
ment bears an impermissible connection to ERISA. It points
to the various reporting, disclosure, and recordkeeping re-
quirements already prescribed under ERISA as evidence of
Congress’s desire to create a nationally uniform system of re-
porting at odds with Rule 128. See 29 U.S.C. §§ 1021–1030.
While the Reporting Requirement is a closer call, we ulti-
mately hold that the Fund has not plausibly alleged that it is
preempted by ERISA.
The Fund’s argument is founded on the Supreme Court’s
decision in Gobeille v. Liberty Mutual Insurance Company.
No. 25-2727 11
Gobeille considered a preemption challenge against a Vermont
law requiring ERISA plans to submit monthly, quarterly, or
annual reports providing “information relating to health care
costs, prices, quality, utilization, or resources” for the purpose
of creating a state-run database. 577 U.S. at 315–16 (citation
omitted). In holding that ERISA preempted the Vermont law,
the Court concluded that “reporting, disclosure, and record-
keeping are central to, and an essential part of, the uniform
system of plan administration contemplated by ERISA.” Id. at
323. There, “[p]re-emption [was] necessary to prevent the
States from imposing novel, inconsistent, and burdensome re-
porting requirements on plans.” Id.
On its face, Gobeille’s reasoning makes us pause here: Rule
128 authorizes the Insurance Commissioner to impose addi-
tional requirements on ERISA plans that threaten the “na-
tional uniformity” in reporting that Congress intended. Id.
But we also must read Gobeille in harmony with Rutledge,
which makes clear that ERISA does not preempt state laws
aimed at the cost of health benefits. These laws, as the Dis-
pensing Fee Requirement demonstrates, will often require
some amount of recordkeeping and reporting to enforce. To
read Gobeille to its limit—to hold that all state reporting re-
quirements per se bear an impermissible connection to ERISA
plans—would necessarily undercut the states’ ability to do ex-
actly what Rutledge allows.
But Gobeille also acknowledged a potential exception that
avoids this tension with Rutledge: “The analysis may be dif-
ferent when applied to a state law, such as a tax on hospitals,
… the enforcement of which necessitates incidental reporting
by ERISA plans[.]” Id. at 325. The Fund asks us to read this
exception as narrowly limited to reporting required for
12 No. 25-2727
instituting taxes. But Gobeille uses state taxes as an example, not
the limit. A better reading of Gobeille is that reporting require-
ments that are both “necesitat[ed]” by and “incidental” to a
state law that is not preempted—for example, a “cost regula-
tion” under Rutledge—do not necessarily bear an impermissi-
ble connection to ERISA plans. Id.
Of course, applying that rule here is difficult because we
lack clear definitions of “necessitated” and “incidental.” The
Sixth Circuit has interpreted this same language as “rein-
forc[ing] the difference between a state law that directly regu-
lates integral aspects of ERISA plan administration and a state
law that touches on these aspects only peripherally.” Self-Insur-
ance Institute of America, Inc. v. Snyder, 827 F.3d 549, 556–57
(6th Cir. 2016) (emphasis added). While the Sixth Circuit’s in-
terpretation is reasonable, we do not see a basis in Gobeille to
distinguish between “direct” and “peripheral” regulations.
We leave for another day the task of drawing the precise con-
tours for what makes reporting “incidental.” At the very least,
“incidental” means “[s]ubordinate to something of greater
importance” or “having a minor role.” Incidental, Black’s Law
Dictionary (12th ed. 2024).
Based on the Fund’s own allegations in its complaint, Rule
128 fits that basic definition. The Fund affirmatively alleges
that Rule 128’s intended purpose is to “ensure that the reim-
bursement for pharmacist services paid to a pharmacist or
pharmacy is ‘fair and reasonable,’” and that “[i]n furtherance
of [Rule 128’s] purpose, Rule 128 includes a reporting obliga-
tion.” Thus, taking the Fund at its word, the Reporting Re-
quirement was not added to Rule 128 for its own sake, as in
No. 25-2727 13
Gobeille. Rather, it exists in “furtherance” of Rule 128’s central
purpose: enforcing fair and reasonable reimbursement rates. 3
Nor does the Fund contest that the Reporting Require-
ment is “necessitate[d]” by Rule 128’s Dispensing Fee Re-
quirement. As noted above, “incidental” is only one aspect of
the Gobeille exception. The state law must “necessitate[] inci-
dental reporting” to avoid preemption. Gobeille, 577 U.S. at
325. But the Fund makes no allegations in its complaint, nor
any arguments on appeal, that the Reporting Requirement
goes beyond what is necessary to carry out Rule 128’s pur-
pose. In fact, it makes the contrary assertion that “without the
data submissions [required by the Reporting Requirement],
Rule 128 has no operative effect.” And similarly, there are no
allegations in the complaint that complying with the Report-
ing Requirement would create a significant burden on the
Fund.
Gobeille makes clear that reporting is a central matter of
plan administration, and that burdensome state reporting re-
quirements can disrupt the uniformity Congress intended to
create with ERISA. Id. at 323. But it also acknowledges that
some state laws that require reporting to facilitate enforce-
ment will fall outside ERISA’s preemptive sweep. Id. at 325.
3 We note that, in evaluating Rule 128’s central purpose, we are not
suggesting that “ERISA does not pre-empt [a] state statute and regulation
because the state reporting scheme has different objectives [than ERISA],”
which Gobeille rejected. 577 U.S. at 324. “Any difference in purpose” be-
tween Rule 128 and ERISA would not “transform [a] direct regulation of
a central matter of plan administration into an innocuous and peripheral
set of additional rules.” Id. (cleaned up). But determining which compo-
nent within Rule 128 is central versus incidental to its own purpose, is a
different inquiry.
14 No. 25-2727
Rule 128, properly aimed at regulating cost under Rutledge, is
one such law. After all, Rule 128 requires the Commissioner
to ensure reimbursement rates are “fair and reasonable.” And
any such determination, just like the levying of a related tax,
requires some degree of record-keeping and reporting.
To be sure, Gobeille’s language is broad, but we must read
it in light of the Court’s later holding in Rutledge. We reject
that Rutledge blessed “cost regulations” like the Dispensing
Fee Requirement only for Gobeille to make it impossible for
Arkansas to enforce such a regulation. Perhaps if there were
allegations that any of the Reporting Requirements were
more exhaustive than necessary, or burdensome beyond an
“incidental” nature, this would be a different case. But given
our record, the Fund has not plausibly alleged that the Re-
porting Requirements are preempted under Gobeille.
We conclude by noting that Congress has recently
amended ERISA § 726 to create new, uniform reporting re-
quirements for similar pharmacy-compensation data that Ar-
kansas now collects under Rule 128. Consolidated Appropri-
ations Act, 2026, Pub. L. No. 119-75, § 6701(b), 140 Stat. 173,
713–22; see 29 U.S.C. § 1185o.
The new requirements, though, only take effect “[f]or plan
years beginning on or after the date that is 30 months after
February 3, 2026.” 29 U.S.C. § 1185o(a). While these new re-
quirements, once in effect, may change our preemption anal-
ysis for Rule 128’s Reporting Requirement, the Fund does not
argue that we must give the requirements preemptive effect
before their operative date. We thus leave for a later day
whether 29 U.S.C. § 1185o will preempt Arkansas Rule 128.
No. 25-2727 15
III. Conclusion
The judgment of the district court is AFFIRMED.