Akerman Tax Partner Lorie Fale tells Health Payer Specialist that Cigna Express Scripts' recent appeals court loss in Maine highlights just how challenging interpreting state tax codes can be for pharmacy benefit managers (PBMs). Fale, who represents a number of PBMs, noted that because the companies operate across multiple states, each with its own tax code, there is constant uncertainty. A PBM will likely pay state tax on either more than or less than 100% of its federal taxable income  – that's how murky the tax regs can be, she said.

“Back in the day when everyone just sold widgets it was a lot easier to figure out, but with PBMs and other services it’s far more nebulous because they do so many things,” Fale told Health Payer.