Supreme Court Ruling May Open the Door for More Widespread Legislation Limiting Power of PBMs

2021-01-11 18:51:00
Tags: retail,payer,reimbursement



In a recent interview with Pharmacy Times, Katea Ravega, JD, partner at Quarles and Brady LLP, discussed the recent Supreme Court ruling in Rutledge v. Pharmaceutical Care Management Association (PCMA) and what it could mean for the future of states’ legislation around pharmacy benefit managers (PBMs).

In their 2020 decision, the Supreme Court upheld Arkansas’ Act 900, which prohibits PBMs from reimbursing pharmacies at a lower rate than what the pharmacies pay to fill prescriptions. Ravega said that although states’ new laws cannot exceed the scope of Act 900, the ruling does open the door for similar legislation.

Although the states all have their own legislation on the books regarding pharmacies and PBMs, Ravega did say she anticipates seeing more such legislation in the future, even as soon as this year depending when each state’s legislature is in session. However, she said the money PBMs lose under such legislation will probably need to be made up elsewhere, whether through higher premiums for patients or other measures.