The battle over pharmacy benefit manager regulation is intensifying across the U.S. With the Supreme Court declining to revisit a key PBM case and Illinois signing sweeping new restrictions into law, PBM oversight remains a complex and evolving issue.
Here are four recent developments to know:
- Supreme Court declines to hear PBM case
The U.S. Supreme Court declined to review a 10th Circuit Court of Appeals decision that struck down portions of Oklahoma’s PBM law. The appellate court ruled the law conflicted with federal statutes regulating Medicare and employer-sponsored health plans.
- States in legal limbo, advocates urge action
Nearly three dozen states and D.C. supported Oklahoma’s case, showing broad interest in favor of PBM regulation, Politico reported July 2. The National Community Pharmacists Association expressed disappointment, warning that “states are confused” about what is permissible.
The Pharmaceutical Care Management Association, which represents pharmacy benefit managers and challenged the Oklahoma law, however, applauded the court’s decision and said similar laws in Iowa, Minnesota, Arkansas and Tennessee could meet the same fate.
- New legal action in Arkansas
PBMs are also taking Arkansas back to court again, this time over a new law banning PBMs from owning retail pharmacies like CVS. PCMA filed a lawsuit challenging Arkansas Act 624, stating the law could force the closure of about 40 pharmacies in the state, including specialty and mail-order providers, and reduce access to medications.
- Illinois signs sweeping PBM reform into law
On July 1, Illinois Gov. J.B. Pritzker signed the Prescription Drug Affordability Act, which prohibits PBMs from directing patients to pharmacies they own and bans spread pricing, the practice of charging insurers more than they reimburse pharmacies, NPR Illinois reported July 1. The law also creates a $25 million annual grant program to support independent pharmacies, funded by a tax on PBMs.
PCMA pushed back, calling the legislation “misguided” and saying it failed to address Big Pharma’s role in setting drug prices.
