I recently authored an article for BenefitsPRO examining the status of pharmacy benefit manager (PBM) regulation in the states. While benefits professionals have seen the cost of prescription drugs rise, there is a lack of consensus as to what exactly is causing the increase. As PBMs serve as the intermediary between prescription drug manufacturers and insurance or benefit providers to help providers save on prescription drugs, PBMs have found themselves under increased scrutiny and the target of litigation and heightened regulation.
In the article, I highlighted some of the state regulations related to PBMs that operate in those jurisdictions. Among other changes, states like Kentucky and Maine have already begun to implement laws regulating PBM drug pricing and pharmacy payments. Idaho and Florida have also implemented regulations, some of which are specifically focused on ensuring that that the amount PBMs paid to a pharmacy is passed through to the plan sponsor without upcharges. Furthermore, like some other states, Vermont and New Jersey’s PBM laws have added license and registration requirements for PBMs operating in their states.
I also discussed reporting and disclosure requirements, as well as the recent federal activity of the National Association of Attorneys General and the Federal Trade Commission with respect to PBM laws. “Benefits professionals should stay apprised of industry developments, particularly in the state(s) in which benefits are being provided,” I advised.
The full article, “The State of PBM Regulation in the States,” was published by BenefitsPRO on December 11 and is available online.