The Current Climate of PBM Reform


Jesse C. Dresser, Esq explains the current climate of PBM reform at the NASP Annual Meeting in Washington, DC.

JD: So, PBMS have started to get the sight set on them. For a long time, they were able to push the blame off onto pharmacies and push the blame onto manufacturers, but the time has come where there’s lawmakers and regulators that are finally starting to kind of ask the question: what is a PBM, what is their real value proposition? In terms of reform, we’ve seen some at the federal level, we’ve seen a recent gag clause prohibition that prohibits the PBM from prohibiting a pharmacies from disclosing a lower cash price to a patient. That’s a step in the right direction. It’s not terribly polarizing in terms of some type of reform. What really needs to happen is there really needs to be keen oversight both on a state level and on the federal level. There are some states that are beginning to license PBMs, beginning to require that PBMs to become licensed ads an actual PBM and apply some of those regulations to those PBMs when they come in. One of the biggest challenges that we see with these state laws is the challenge under ERISA. ERISA is a federal statute that essentially preempts state laws that deal with employee benefits. And so one of the real challenges for state legislators is to draft adequate laws that provide enough protection for patients or for the pharmacy or for the broader community but don’t get into that realm of being preemptive by ERISA.

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