PBM Reform Is Getting Real
PUTT Blog / PUTTRx Medium
It’s feeling a lot like PBM reform is getting really real as the largest pharmacy benefit managers, especially those that might own or exert enormous influence over large retail pharmacies, come under fire for issues related to real-world concerns for patient safety, drug pricing and limiting access to medications.
First up, and perhaps the most exciting development this month, the 8th Circuit Court of Appeals released its verdict in PCMA v. Webhi, with the outcome decisively upholding the U.S. Supreme Court’s Rutledge v. PCMA verdict that says certain practices by PBMs toward network pharmacies are not preempted by ERISA. What it means: states can confidently move forward in their attempts to regulate PBMs without PCMA playing the ERISA card every 5 minutes.
Until Arkansas Attorney General Leslie Rutledge took on PCMA last year, ERISA (the Employee Retirement Income Security Act) had been a favorite fallback of the PBM lobby... Continue Reading
ACROSS THE NATION
Documents Reveal the Secrecy of America's Drug Pricing Matrix
December 6, 2021
American businesses spend hundreds of billions of dollars a year on prescription drugs, and the bills keep getting bigger. But some of the companies promising to help rein in those costs prevent employers from looking under the hood.
Why it matters: Documents provided to Axios reveal a new layer of secrecy within the maze of American drug pricing — one in which firms that manage drug coverage for hundreds of employers, representing millions of workers, obscure the details of their work and make it difficult to figure out whether they're actually providing a good deal.
The big picture: Americans spent $370 billion on retail prescription drugs in 2019, and employers shouldered about $166 billion of that, according to federal data.