{"attribution":{"source":"legal.exploreworldai.com","canonical":"https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca8-25-3068-2026-06-29","cite_as":"NovaCopilot, legal.exploreworldai.com (https://legal.exploreworldai.com/api/public/v1/judgment-text?id=us:ca8-25-3068-2026-06-29)","license":"https://legal.exploreworldai.com/revision","version":"legal-2026-10-13","fingerprint":"ewai:us:97516d","proof":"sha256:27d76a05f33560ae9752a4ed98a8e3d44c452e23c62aa0131d742ebf71d14b67","jurisdiction":"us","lang":"en","publisher":"NovaCopilot by ExploreWorld Legal","terms":"https://legal.exploreworldai.com/om"},"brand_source":"Source: NovaCopilot","item":{"schema_version":"1.0.0","id":"us:ca8-25-3068-2026-06-29","jurisdiction":"us","lang":"en","brand_source":"Source: NovaCopilot","brand":{"product":"NovaCopilot","platform":"ExploreWorldAI","infrastructure":"ExploreWorld Legal","infrastructure_url":"legal.exploreworldai.com","legal_entity":"Valkiv Ventures AB","permanent_url":"https://legal.exploreworldai.com/novacopilot","source":"Source: NovaCopilot","powered_by":"Powered by NovaCopilot","license":"https://legal.exploreworldai.com/licensvillkor"},"sections":[{"title":"Front matter","paragraphs":["para_1","para_2","para_3","para_4","para_5","para_6","para_7","para_8","para_9","para_10","para_11","para_12","para_13","para_14","para_15","para_16","para_17","para_18","para_19","para_20","para_21","para_22","para_23","para_24","para_25","para_26","para_27","para_28","para_29","para_30","para_31","para_32","para_33","para_34","para_35","para_36","para_37","para_38","para_39","para_40","para_41","para_42","para_43","para_44","para_45","para_46","para_47","para_48","para_49","para_50","para_51","para_52","para_53","para_54","para_55","para_56","para_57","para_58","para_59","para_60","para_61","para_62","para_63","para_64","para_65","para_66","para_67","para_68","para_69","para_70","para_71","para_72","para_73","para_74","para_75","para_76","para_77","para_78","para_79","para_80","para_81","para_82","para_83","para_84","para_85","para_86","para_87","para_88","para_89","para_90","para_91","para_92","para_93","para_94","para_95","para_96","para_97","para_98","para_99","para_100","para_101","para_102","para_103","para_104","para_105","para_106","para_107","para_108","para_109","para_110","para_111","para_112","para_113","para_114","para_115","para_116","para_117","para_118","para_119","para_120","para_121","para_122","para_123","para_124","para_125","para_126","para_127","para_128","para_129","para_130","para_131","para_132","para_133","para_134","para_135","para_136","para_137","para_138","para_139","para_140","para_141","para_142","para_143","para_144","para_145","para_146","para_147","para_148","para_149","para_150","para_151","para_152","para_153","para_154","para_155","para_156","para_157","para_158","para_159","para_160","para_161","para_162","para_163","para_164","para_165","para_166","para_167","para_168","para_169","para_170","para_171","para_172","para_173","para_174","para_175","para_176","para_177","para_178","para_179","para_180","para_181","para_182","para_183","para_184","para_185","para_186","para_187","para_188","para_189","para_190","para_191","para_192","para_193","para_194","para_195","para_196","para_197","para_198","para_199","para_200","para_201","para_202","para_203","para_204","para_205","para_206","para_207","para_208","para_209","para_210","para_211","para_212","para_213","para_214","para_215","para_216","para_217","para_218","para_219","para_220","para_221","para_222","para_223","para_224","para_225","para_226","para_227","para_228","para_229","para_230","para_231","para_232","para_233","para_234","para_235","para_236","para_237","para_238","para_239","para_240","para_241","para_242","para_243","para_244","para_245","para_246","para_247","para_248","para_249","para_250","para_251","para_252","para_253","para_254","para_255","para_256","para_257","para_258","para_259","para_260","para_261","para_262","para_263","para_264","para_265","para_266","para_267","para_268","para_269","para_270","para_271","para_272","para_273","para_274","para_275","para_276","para_277","para_278","para_279","para_280","para_281","para_282","para_283","para_284","para_285","para_286","para_287","para_288"],"kind":"front_matter"}],"paragraphs":[{"text":"United States Court of Appeals","paragraph_id":"para_1"},{"text":"For the Eighth Circuit","paragraph_id":"para_2"},{"text":"___________________________","paragraph_id":"para_3"},{"text":"No. 25-3068","paragraph_id":"para_4"},{"text":"___________________________","paragraph_id":"para_5"},{"text":"Kevin Flowers, on Behalf of Himself and Other Arkansans Similarly Situated","paragraph_id":"para_6"},{"text":"Plaintiff - Appellant","paragraph_id":"para_7"},{"text":"v.","paragraph_id":"para_8"},{"text":"Caremark PCS Health, LLC, doing business as CVS Caremark; CaremarkPCS","paragraph_id":"para_9"},{"text":"Pennsylvania Mail Pharmacy, LLC","paragraph_id":"para_10"},{"text":"Defendants - Appellees","paragraph_id":"para_11"},{"text":"____________","paragraph_id":"para_12"},{"text":"Appeal from United States District Court","paragraph_id":"para_13"},{"text":"for the Western District of Arkansas - Texarkana","paragraph_id":"para_14"},{"text":"____________","paragraph_id":"para_15"},{"text":"Submitted: April 14, 2026","paragraph_id":"para_16"},{"text":"Filed: June 29, 2026","paragraph_id":"para_17"},{"text":"____________","paragraph_id":"para_18"},{"text":"Before GRUENDER, BENTON, and ERICKSON, Circuit Judges.","paragraph_id":"para_19"},{"text":"____________","paragraph_id":"para_20"},{"text":"GRUENDER, Circuit Judge.","paragraph_id":"para_21"},{"text":"Kevin Flowers filed this class action suit against CaremarkPCS Health, LLC","paragraph_id":"para_22"},{"text":"and CaremarkPCS Pennsylvania Mail Pharmacy, LLC (collectively, “Caremark”),","paragraph_id":"para_23"},{"text":"claiming that Caremark unjustly enriches itself by failing to provide an adequate","paragraph_id":"para_24"},{"text":"-2-","paragraph_id":"para_25"},{"text":"pharmacy network as required under Arkansas law. The district court1 granted","paragraph_id":"para_26"},{"text":"Caremark’s motion to dismiss. We affirm.","paragraph_id":"para_27"},{"text":"I.","paragraph_id":"para_28"},{"text":"Kevin Flowers participates in an employee benefits plan governed by the","paragraph_id":"para_29"},{"text":"Employee Retirement Income Security Act of 1974 (“ERISA”). Through this plan,","paragraph_id":"para_30"},{"text":"Flowers receives a prescription drug benefit. Caremark, as a pharmacy benefits","paragraph_id":"para_31"},{"text":"manager (“PBM”), administers that benefit.2 In doing so, Caremark maintains","paragraph_id":"para_32"},{"text":"provider networks of pharmacies where plan members can fill their prescriptions.","paragraph_id":"para_33"},{"text":"Flowers alleges that Caremark covers plan members’ “maintenance prescriptions,”","paragraph_id":"para_34"},{"text":"i.e., prescriptions taken regularly for more than ninety days, only if plan members","paragraph_id":"para_35"},{"text":"fill those prescriptions “at one of its CVS retail pharmacy stores or through its mail-","paragraph_id":"para_36"},{"text":"order delivery service.” Flowers claims that, by permitting only these options,","paragraph_id":"para_37"},{"text":"Caremark violates two Arkansas statutes and thereby unjustly enriches itself.3","paragraph_id":"para_38"},{"text":"First, Flowers claims that Caremark violates Ark. Code Ann. § 17-92-","paragraph_id":"para_39"},{"text":"119(b)(2) (the “Mail Order Provision”). In relevant part, the Mail Order Provision","paragraph_id":"para_40"},{"text":"states that “[i]f a pharmacy . . . is owned or controlled by . . . [a] pharmacy benefits","paragraph_id":"para_41"},{"text":"manager, . . . then the pharmacy, including any common ownership or controlling","paragraph_id":"para_42"},{"text":"entities, . . . shall not require that a patient receive his or her prescriptions through","paragraph_id":"para_43"},{"text":"1The Honorable Susan O. Hickey, United States District Judge for the Western","paragraph_id":"para_44"},{"text":"District of Arkansas.","paragraph_id":"para_45"},{"text":"2Caremark states that CaremarkPCS Pennsylvania Mail Pharmacy, LLC is not","paragraph_id":"para_46"},{"text":"a PBM, but Flowers alleges otherwise in his complaint, and at the motion to dismiss","paragraph_id":"para_47"},{"text":"stage, we assume that all facts Flowers alleges in his complaint are true. See Zutz v.","paragraph_id":"para_48"},{"text":"Nelson, 601 F.3d 842, 848 (8th Cir. 2010).","paragraph_id":"para_49"},{"text":"3Flowers initially also brought claims for (1) a violation of Arkansas’s Unfair","paragraph_id":"para_50"},{"text":"Practices Act (“AUPA”), see Ark. Code. Ann. § 4-75-201 et seq., and","paragraph_id":"para_51"},{"text":"(2) “declaratory and injunctive relief.” But these claims are not at issue because the","paragraph_id":"para_52"},{"text":"parties stipulated to dismissal of Flowers’s AUPA claim and agreed that Flowers’s","paragraph_id":"para_53"},{"text":"claim for “declaratory and injunctive relief” is not an independent cause of action.","paragraph_id":"para_54"},{"text":"-3-","paragraph_id":"para_55"},{"text":"home delivery services.” § 17-92-119(b)(2). Flowers asserts that, by requiring plan","paragraph_id":"para_56"},{"text":"members to fill their maintenance prescriptions either at Caremark CVS retail","paragraph_id":"para_57"},{"text":"pharmacies or by mail, Caremark violates this requirement.","paragraph_id":"para_58"},{"text":"Second, Flowers claims that Caremark violates Ark. Code Ann. § 23-92-","paragraph_id":"para_59"},{"text":"505(a)(1)(A) (the “Network Adequacy Provision”). The Network Adequacy","paragraph_id":"para_60"},{"text":"Provision requires PBMs to provide “[a] reasonably adequate and accessible [PBM]","paragraph_id":"para_61"},{"text":"network for the provision of prescription drugs . . . [with] convenient patient access","paragraph_id":"para_62"},{"text":"to pharmacies within a reasonable distance from a patient’s residence.” § 23-92-","paragraph_id":"para_63"},{"text":"505(a)(1)(A). Flowers asserts that, by requiring plan members to fill their","paragraph_id":"para_64"},{"text":"maintenance prescriptions either at Caremark CVS retail pharmacies or by mail,","paragraph_id":"para_65"},{"text":"Caremark violates this requirement as well, thereby forcing many plan members like","paragraph_id":"para_66"},{"text":"him to pay out of pocket to fill their maintenance prescriptions at local pharmacies.","paragraph_id":"para_67"},{"text":"Caremark moved to dismiss under Federal Rule of Civil Procedure 12(b)(6),","paragraph_id":"para_68"},{"text":"arguing that Flowers failed to plausibly plead a violation of the Mail Order Provision","paragraph_id":"para_69"},{"text":"and that both the Mail Order Provision and the Network Adequacy Provision are","paragraph_id":"para_70"},{"text":"preempted by ERISA. The district court granted Caremark’s motion. Flowers","paragraph_id":"para_71"},{"text":"appeals.","paragraph_id":"para_72"},{"text":"II.","paragraph_id":"para_73"},{"text":"“We review de novo the district court’s grant of a Rule 12(b)(6) motion to","paragraph_id":"para_74"},{"text":"dismiss.” Pharm. Care Mgmt. Ass’n v. Gerhart, 852 F.3d 722, 726 (8th Cir. 2017).","paragraph_id":"para_75"},{"text":"To survive a motion to dismiss, “a complaint must contain sufficient factual matter,","paragraph_id":"para_76"},{"text":"accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v.","paragraph_id":"para_77"},{"text":"Iqbal, 556 U.S. 662, 678 (2009). Here, Flowers has failed to state a plausible claim","paragraph_id":"para_78"},{"text":"that Caremark unjustly enriched itself by violating the Mail Order Provision and the","paragraph_id":"para_79"},{"text":"Network Adequacy Provision.","paragraph_id":"para_80"},{"text":"We can quickly dispense with Flowers’s claim that Caremark violated the","paragraph_id":"para_81"},{"text":"Mail Order Provision. This provision prohibits PBMs from requiring that patients","paragraph_id":"para_82"},{"text":"receive their prescriptions through home delivery services. See § 17-92-119(b)(2).","paragraph_id":"para_83"},{"text":"-4-","paragraph_id":"para_84"},{"text":"But Caremark, as alleged, requires plan members to fill their maintenance","paragraph_id":"para_85"},{"text":"prescriptions either by mail or at CVS pharmacies. Therefore, Flowers has not","paragraph_id":"para_86"},{"text":"alleged facts sufficient to show that Caremark requires patients to fill prescriptions","paragraph_id":"para_87"},{"text":"only through home delivery services. As Caremark rightly points out, Flowers has","paragraph_id":"para_88"},{"text":"thus failed to plausibly plead that it violated the Mail Order Provision. See Iqbal,","paragraph_id":"para_89"},{"text":"556 U.S. at 678.4","paragraph_id":"para_90"},{"text":"Flowers’s remaining claim, that Caremark violated the Network Adequacy","paragraph_id":"para_91"},{"text":"Provision, is more complicated. As noted above, this provision requires PBMs to","paragraph_id":"para_92"},{"text":"provide a “reasonably adequate and accessible” network. See Ark. Code Ann. § 23-","paragraph_id":"para_93"},{"text":"92-505. The Network Adequacy Provision does not define “reasonably adequate","paragraph_id":"para_94"},{"text":"and accessible.” But a different statutory provision requires Arkansas’s Insurance","paragraph_id":"para_95"},{"text":"Commissioner to “adopt rules relating to a pharmacy benefits manager’s network","paragraph_id":"para_96"},{"text":"adequacy.” § 23-92-509(2)(A). And pursuant to this delegated authority, the","paragraph_id":"para_97"},{"text":"commissioner promulgated implementing regulations clarifying that “a pharmacy","paragraph_id":"para_98"},{"text":"network is adequate if the pharmacy network meets [certain] network adequacy","paragraph_id":"para_99"},{"text":"distances.” Code Ark. R. 003.22.118-7(A)(1)-(2) (citing § 23-92-505). As Flowers","paragraph_id":"para_100"},{"text":"and Caremark observe, these regulations require PBMs to ensure that:","paragraph_id":"para_101"},{"text":"(i) At least ninety percent (90%) of individuals covered by a health","paragraph_id":"para_102"},{"text":"benefit plan in an urban area served by the health benefit plan . . . live","paragraph_id":"para_103"},{"text":"within two (2) miles of a network pharmacy that is a retail community","paragraph_id":"para_104"},{"text":"pharmacy;","paragraph_id":"para_105"},{"text":"(ii) At least ninety percent (90%) of individuals covered by a health","paragraph_id":"para_106"},{"text":"benefit plan in suburban areas served by the health benefit plan . . . live","paragraph_id":"para_107"},{"text":"within five (5) miles of a network pharmacy that is a retail community","paragraph_id":"para_108"},{"text":"pharmacy; and","paragraph_id":"para_109"},{"text":"(iii) At least seventy percent (70%) of individuals covered by a health","paragraph_id":"para_110"},{"text":"benefit plan in a rural area served by the health benefit plan . . . live","paragraph_id":"para_111"},{"text":"within fifteen (15) miles of a network pharmacy that is a retail","paragraph_id":"para_112"},{"text":"community pharmacy.","paragraph_id":"para_113"},{"text":"4We need not reach whether ERISA preempts the Mail Order Provision.","paragraph_id":"para_114"},{"text":"-5-","paragraph_id":"para_115"},{"text":"§ 23-92-509(b)(2)(B)(i)-(iii); see Code Ark. R. 003.22.118-7(A)(1)-(2) (adopting","paragraph_id":"para_116"},{"text":"“the standards in Ark. Code Ann. § 23-92-509(b)(2)(B)”). To summarize, the","paragraph_id":"para_117"},{"text":"Network Adequacy Provision’s implementing regulations require PBMs to ensure","paragraph_id":"para_118"},{"text":"that certain minimum percentages of plan members live within specified distances","paragraph_id":"para_119"},{"text":"of an in-network, retail community pharmacy. We will label these requirements,","paragraph_id":"para_120"},{"text":"reproduced above, as the “Geographic Coverage Requirements.”","paragraph_id":"para_121"},{"text":"We pause here to make two observations. First, Flowers’s theory for why","paragraph_id":"para_122"},{"text":"Caremark violates the Network Adequacy Provision appears to be that Caremark","paragraph_id":"para_123"},{"text":"violates the Geographic Coverage Requirements. Flowers explains that the Network","paragraph_id":"para_124"},{"text":"Adequacy Provision “merely requires the inclusion of local pharmacies in networks","paragraph_id":"para_125"},{"text":"so that beneficiaries may choose to fill their prescriptions locally.” He states that","paragraph_id":"para_126"},{"text":"“§ 2-92-509 establishes the rules governing pharmacy benefit network adequacy.”","paragraph_id":"para_127"},{"text":"And invoking the Geographic Coverage Requirements, he notes that “[r]easonable","paragraph_id":"para_128"},{"text":"adequacy and accessibility requires that minimum percentages of individuals","paragraph_id":"para_129"},{"text":"covered by a plan must live within a specified distance of a ‘network pharmacy that","paragraph_id":"para_130"},{"text":"is a retail community pharmacy.’”","paragraph_id":"para_131"},{"text":"Second, however, we have found no factual allegations in Flowers’s","paragraph_id":"para_132"},{"text":"complaint, aside from that Caremark requires plan members to fill certain","paragraph_id":"para_133"},{"text":"prescriptions at a CVS retail pharmacy or by mail, to show that Caremark violates","paragraph_id":"para_134"},{"text":"the Geographic Coverage Requirements—or that Caremark otherwise fails to","paragraph_id":"para_135"},{"text":"provide a reasonably adequate and accessible network. To illustrate, Flowers makes","paragraph_id":"para_136"},{"text":"no factual allegations describing the number or location of CVS retail pharmacies or","paragraph_id":"para_137"},{"text":"plan members’ proximity to those pharmacies. Nonetheless, because Caremark has","paragraph_id":"para_138"},{"text":"not raised this point, we proceed to the parties’ primary focus on appeal: whether","paragraph_id":"para_139"},{"text":"ERISA preempts the Geographic Coverage Requirements.5 See Ivey v. Audrain","paragraph_id":"para_140"},{"text":"5In our view, the proper analysis is not whether ERISA preempts the Network","paragraph_id":"para_141"},{"text":"Adequacy Provision as a whole, but instead whether ERISA preempts, specifically,","paragraph_id":"para_142"},{"text":"the Geographic Coverage Requirements imposed by the provision’s implementing","paragraph_id":"para_143"},{"text":"regulations. The district court held that ERISA preempts the Network Adequacy","paragraph_id":"para_144"},{"text":"Provision. But its discussion focused on “geographic parameters” (i.e., the","paragraph_id":"para_145"},{"text":"-6-","paragraph_id":"para_146"},{"text":"Cnty., 968 F.3d 845. 850-51 (8th Cir. 2020) (“Though we may affirm a district","paragraph_id":"para_147"},{"text":"court’s decision on any ground that the record supports, . . . we usually do so when","paragraph_id":"para_148"},{"text":"a party advances that alternative ground, not when we raise the matter sua sponte","paragraph_id":"para_149"},{"text":"without giving the appellant a chance to respond.”).","paragraph_id":"para_150"},{"text":"Although preemption is generally an affirmative defense, see Wuebker v.","paragraph_id":"para_151"},{"text":"Wilbur-Ellis Co., 418 F.3d 883, 886 (8th Cir. 2005), this defense can warrant","paragraph_id":"para_152"},{"text":"dismissal under Rule 12(b)(6) if it is “apparent on the face of the complaint.”","paragraph_id":"para_153"},{"text":"Stephens v. Target Corp., 694 F. Supp. 3d 1136, 1142 (D. Minn. 2023) (quoting","paragraph_id":"para_154"},{"text":"Noble Sys. Corp. v. Alorica Cent., LLC, 543 F.3d 978, 983 (8th Cir. 2008)). At this","paragraph_id":"para_155"},{"text":"stage, we can therefore evaluate whether ERISA preempts the Geographic Coverage","paragraph_id":"para_156"},{"text":"Requirements, provided that we review only “the materials properly before [us] on","paragraph_id":"para_157"},{"text":"a motion to dismiss.” See Noble Sys., 543 F.3d at 983; see also Zean v. Fairview","paragraph_id":"para_158"},{"text":"Health Servs., 858 F.3d 520, 526 (8th Cir. 2017).","paragraph_id":"para_159"},{"text":"We review de novo “the question of whether ERISA preempts a State law.”","paragraph_id":"para_160"},{"text":"Gerhart, 852 F.3d at 726. ERISA expressly preempts “any and all State laws insofar","paragraph_id":"para_161"},{"text":"as they may now or hereafter relate to any employee benefit plan” that ERISA","paragraph_id":"para_162"},{"text":"governs. See 29 U.S.C. § 1144(a); Gobeille v. Liberty Mut. Ins. Co., 577 U.S. 312,","paragraph_id":"para_163"},{"text":"319 (2016). “[A] state law relates to an ERISA plan if it has a connection with or","paragraph_id":"para_164"},{"text":"reference to such a plan.” Egelhoff v. Egelhoff ex rel. Breiner, 532 U.S. 141, 147","paragraph_id":"para_165"},{"text":"(2001). As the district court observed, Caremark focuses solely on “the ‘connection","paragraph_id":"para_166"},{"text":"with’ part of this inquiry,” see id., arguing that the Geographic Coverage","paragraph_id":"para_167"},{"text":"Requirements impermissibly connect with ERISA plans.","paragraph_id":"para_168"},{"text":"Geographic Coverage Requirements), which come not from the Network Adequacy","paragraph_id":"para_169"},{"text":"Provision but instead from its implementing regulations. See Code Ark. R.","paragraph_id":"para_170"},{"text":"003.22.118-7(A)(1)-(2) (adopting requirements from § 2-92-509(b)(2)(B)(i)-(iii)).","paragraph_id":"para_171"},{"text":"And accordingly, the parties’ arguments on appeal focus on the Geographic","paragraph_id":"para_172"},{"text":"Coverage Requirements. We thus expressly leave open the question of whether the","paragraph_id":"para_173"},{"text":"Network Adequacy Provision, standing on its own or implemented through different","paragraph_id":"para_174"},{"text":"regulations, would be preempted by ERISA.","paragraph_id":"para_175"},{"text":"-7-","paragraph_id":"para_176"},{"text":"To determine if a state law has an impermissible connection with ERISA","paragraph_id":"para_177"},{"text":"plans, “we look both to the objectives of the ERISA statute as a guide to the scope","paragraph_id":"para_178"},{"text":"of the state law that Congress understood would survive as well as to the nature of","paragraph_id":"para_179"},{"text":"the effect of the state law on ERISA plans.” Id. (citation modified). Therefore, we","paragraph_id":"para_180"},{"text":"have held that a state law impermissibly connects with an ERISA plan “if and only","paragraph_id":"para_181"},{"text":"if (1) it ‘governs a central matter of plan administration’; (2) it ‘interferes with","paragraph_id":"para_182"},{"text":"nationally uniform plan administration’; or (3) ‘acute, albeit indirect economic","paragraph_id":"para_183"},{"text":"effects of the law force an ERISA plan to adopt a certain scheme of substantive","paragraph_id":"para_184"},{"text":"coverage or effectively restrict its choice of insurers.’” Pharm. Care Mgmt. Ass’n","paragraph_id":"para_185"},{"text":"v. Wehbi, 18 F.4th 956, 968 (8th Cir. 2021) (quoting Gobeille, 577 U.S. at 320)","paragraph_id":"para_186"},{"text":"(citation modified). “Crucially, not every state law that affects an ERISA plan or","paragraph_id":"para_187"},{"text":"causes some disuniformity in plan administration has an impermissible connection","paragraph_id":"para_188"},{"text":"with an ERISA plan.” Rutledge v. Pharm. Care Mgmt. Ass’n, 592 U.S. 80, 87","paragraph_id":"para_189"},{"text":"(2020). “ERISA is . . . primarily concerned with pre-empting laws that require","paragraph_id":"para_190"},{"text":"providers to structure benefit plans in particular ways, such as by requiring payment","paragraph_id":"para_191"},{"text":"of specific benefits or by binding plan administrators to specific rules for","paragraph_id":"para_192"},{"text":"determining beneficiary status.” Id. And “pre-emption does not occur if the state","paragraph_id":"para_193"},{"text":"law has only a tenuous, remote, or peripheral connection with covered plans, as is","paragraph_id":"para_194"},{"text":"the case with many laws of general applicability.” N.Y. State Conf. of Blue Cross &","paragraph_id":"para_195"},{"text":"Blue Shield Plans v. Travelers Ins. Co., 514 U.S. 645, 661 (1995) (citation","paragraph_id":"para_196"},{"text":"modified).","paragraph_id":"para_197"},{"text":"Applying these principles in Wehbi, we evaluated whether certain provisions","paragraph_id":"para_198"},{"text":"of a North Dakota law that regulated PBMs had an impermissible connection with","paragraph_id":"para_199"},{"text":"ERISA plans. See 18 F.4th at 964-66, 968-69. We explained that, as a threshold","paragraph_id":"para_200"},{"text":"matter, “because PBMs manage benefits on behalf of plans, a regulation of PBMs","paragraph_id":"para_201"},{"text":"functions as a regulation of an ERISA plan itself.” See id. at 966 (citation modified).","paragraph_id":"para_202"},{"text":"But, as Flowers observes, we upheld two statutory provisions (the “Accreditation","paragraph_id":"para_203"},{"text":"Provisions”) that prohibited a PBM from imposing pharmacy accreditation","paragraph_id":"para_204"},{"text":"requirements “as a condition for participation in its network” that were “inconsistent","paragraph_id":"para_205"},{"text":"with, more stringent than, or in addition to federal and state requirements for","paragraph_id":"para_206"},{"text":"licensure as a pharmacy in [the] state.” Id. at 968, 965-66 (citing ND. Cent. Code","paragraph_id":"para_207"},{"text":"-8-","paragraph_id":"para_208"},{"text":"Ann. § 19-02.1-16.1.11, -16.2.4). We determined that the Accreditation Provisions","paragraph_id":"para_209"},{"text":"bore none of the three qualities that constitute an impermissible connection with","paragraph_id":"para_210"},{"text":"ERISA plans. See id. at 968. The Accreditation Provisions governed only a","paragraph_id":"para_211"},{"text":"“noncentral” matter of plan administration. Id. They had, at most, “de minimis","paragraph_id":"para_212"},{"text":"economic effects.” Id. And although they might have caused “some disuniformity","paragraph_id":"para_213"},{"text":"in plan administration [across states] by requiring PBMs to maintain different","paragraph_id":"para_214"},{"text":"accreditation requirements in different states,” any disuniformity was, at most,","paragraph_id":"para_215"},{"text":"“modest.” Id. (citation modified).","paragraph_id":"para_216"},{"text":"Here, however, the Geographic Coverage Requirements cause a far less","paragraph_id":"para_217"},{"text":"“modest” disuniformity in plan administration than the Accreditation Provisions in","paragraph_id":"para_218"},{"text":"Wehbi. Although the Geographic Coverage Requirements nominally permit PBMs","paragraph_id":"para_219"},{"text":"to retain some flexibility to design their networks, the requirements “forc[e] . . . [a]","paragraph_id":"para_220"},{"text":"particular scheme of substantive coverage.” See Rutledge, 592 U.S. at 88; see also","paragraph_id":"para_221"},{"text":"Pharm. Care Mgmt. Ass’n v. Mulready, 78 F.4th 1183, 1201 n.14 (10th Cir. 2023)","paragraph_id":"para_222"},{"text":"(“Nor does ERISA preempt only state laws that bind health plans to a specific","paragraph_id":"para_223"},{"text":"choice.” (citation modified)). At minimum, the Geographic Coverage Requirements","paragraph_id":"para_224"},{"text":"force PBMs to ensure that ninety percent of plan members in “an urban area” live","paragraph_id":"para_225"},{"text":"within two miles of an in-network, retail community pharmacy; ninety percent of","paragraph_id":"para_226"},{"text":"plan members in “suburban areas” live within five miles of such a pharmacy; and","paragraph_id":"para_227"},{"text":"seventy percent of plan members in “a rural area” live within fifteen miles of such a","paragraph_id":"para_228"},{"text":"pharmacy. See § 23-92-509(b)(2)(B)(i)-(iii). If a plan member moves from an urban","paragraph_id":"para_229"},{"text":"area to a rural one or from one block to another, or a rural area becomes a suburban","paragraph_id":"para_230"},{"text":"area, or an in-network pharmacy closes down, PBMs must adjust their networks","paragraph_id":"para_231"},{"text":"accordingly. And consider Congress’s objectives. Congress enacted ERISA to","paragraph_id":"para_232"},{"text":"“minimiz[e] the administrative and financial burden of complying with conflicting","paragraph_id":"para_233"},{"text":"directives and ensur[e] that plans do not have to tailor substantive benefits to the","paragraph_id":"para_234"},{"text":"particularities of multiple jurisdictions.” Rutledge, 592 U.S. at 86 (citation","paragraph_id":"para_235"},{"text":"modified). The Geographic Coverage Requirements bulldoze through these","paragraph_id":"para_236"},{"text":"objectives, requiring PBMs to tailor and retailor their networks—and perhaps even","paragraph_id":"para_237"},{"text":"build new brick-and-mortar pharmacies—to comply with a set of exacting","paragraph_id":"para_238"},{"text":"particularities.","paragraph_id":"para_239"},{"text":"-9-","paragraph_id":"para_240"},{"text":"Contrast the Geographic Coverage Requirements with the Accreditation","paragraph_id":"para_241"},{"text":"Provisions in Wehbi. The Accreditation Provisions gave a simple, easily","paragraph_id":"para_242"},{"text":"administrable instruction to PBMs: PBMs could not impose accreditation","paragraph_id":"para_243"},{"text":"requirements on pharmacies other than federal and state licensing requirements, see","paragraph_id":"para_244"},{"text":"Wehbi, 18 F.4th at 965-66. To comply with the Accreditation Provisions, PBMs","paragraph_id":"para_245"},{"text":"needed only to (1) know what those federal and state licensing requirements were,","paragraph_id":"para_246"},{"text":"which PBMs would need to do anyway, and (2) not impose other accreditation","paragraph_id":"para_247"},{"text":"requirements. Any resulting disuniformity in plan administration was modest.","paragraph_id":"para_248"},{"text":"Further, contrary to Flowers’s arguments, Wehbi never announced a broad","paragraph_id":"para_249"},{"text":"rule that laws regulating pharmacy network composition govern a noncentral matter","paragraph_id":"para_250"},{"text":"of plan administration. Instead, we held that the particular provisions in Wehbi—","paragraph_id":"para_251"},{"text":"which limited the accreditation requirements PBMs could impose on pharmacies—","paragraph_id":"para_252"},{"text":"governed a noncentral matter of plan administration. See 18 F.4th at 968; see also","paragraph_id":"para_253"},{"text":"Iowa Ass’n of Bus. & Indus. v. Ommen, 799 F. Supp. 3d 795, 826 (S.D. Iowa 2025)","paragraph_id":"para_254"},{"text":"(distinguishing the provisions in Wehbi from other laws affecting PBM networks).","paragraph_id":"para_255"},{"text":"Similarly, Wehbi never announced a broad rule that laws regulating pharmacy","paragraph_id":"para_256"},{"text":"network composition necessarily have only de minimis economic effects. In Wehbi,","paragraph_id":"para_257"},{"text":"we assessed particular provisions’ economic effects after reviewing a fact record","paragraph_id":"para_258"},{"text":"developed before summary judgment. See 18 F.4th at 966. Here, at the motion to","paragraph_id":"para_259"},{"text":"dismiss stage, the record on the Geographic Coverage Requirements’ economic","paragraph_id":"para_260"},{"text":"effects is not developed enough to permit such an assessment. In any event, given","paragraph_id":"para_261"},{"text":"the Geographic Coverage Requirements’ interference with plan administration","paragraph_id":"para_262"},{"text":"uniformity, we need not resolve whether they constitute “regulation of a noncentral","paragraph_id":"para_263"},{"text":"‘matter of plan administration’ with de minimis economic effects.” See Wehbi, 18","paragraph_id":"para_264"},{"text":"F.4th at 968. Either way, ERISA preempts them.","paragraph_id":"para_265"},{"text":"Flowers points out that the Geographic Coverage Requirements neither","paragraph_id":"para_266"},{"text":"“require payment of specific benefits” nor “bind plan administrators to specific rules","paragraph_id":"para_267"},{"text":"for determining beneficiary status.” See id. (citation modified). But these are simply","paragraph_id":"para_268"},{"text":"illustrations—not an exhaustive overview—of how state laws might “structure","paragraph_id":"para_269"},{"text":"benefit plans in particular ways” and thereby risk running afoul of ERISA. See id.;","paragraph_id":"para_270"},{"text":"-10-","paragraph_id":"para_271"},{"text":"Rutledge, 592 U.S. at 86-87; see also Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 98","paragraph_id":"para_272"},{"text":"(1983) (noting that ERISA’s express-preemption provision, 29 U.S.C. § 1144(a),","paragraph_id":"para_273"},{"text":"cannot “be interpreted to pre-empt only state laws dealing with the subject matters","paragraph_id":"para_274"},{"text":"covered by ERISA”). ERISA can also preempt state laws that do not perform these","paragraph_id":"para_275"},{"text":"functions.","paragraph_id":"para_276"},{"text":"We conclude that the Geographic Coverage Requirements are preempted and","paragraph_id":"para_277"},{"text":"therefore “without effect.” See Cipollone v. Liggett Grp., Inc., 505 U.S. 504, 516","paragraph_id":"para_278"},{"text":"(1992). Flowers’s argument that Caremark violates them does not amount to a","paragraph_id":"para_279"},{"text":"plausible claim of unjust enrichment.6 See Iqbal, 556 U.S. at 678.","paragraph_id":"para_280"},{"text":"III.","paragraph_id":"para_281"},{"text":"For the foregoing reasons, we affirm.","paragraph_id":"para_282"},{"text":"______________________________","paragraph_id":"para_283"},{"text":"6As alternative grounds for affirmance, Caremark argues that (1) Arkansas has","paragraph_id":"para_284"},{"text":"not recognized an unjust enrichment claim for a violation of a statute that lacks a","paragraph_id":"para_285"},{"text":"private right of action, and (2) Flowers’s unjust enrichment claim fails because he","paragraph_id":"para_286"},{"text":"has not alleged that he, personally, conferred any benefit to Caremark. 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