States may be getting ready to crack down even harder on pharmacy benefit managers.
The National Association of Insurance Commissioners will be giving member regulators a crash course on PBM policy next week in Denver, at the NAIC’s fall national meeting.
PBMs help health insurers and self-insured employer health plans cover prescription drugs.
One NAIC panel, the Regulatory Framework Task Force, plans to hear a presentation on PBM transparency initiatives by Rob Nolan, the chief compliance officer at AffirmedRx, Sunday.
AffirmedRx is a new PBM that says it’s more transparent than the big PBMs.
A task force subgroup, the Pharmaceutical Benefit Management Regulatory Issues Working Group, plans to hear three presentations on PBMs Monday.
The Pharmaceutical Care Management Association, a PBM group, is sending John Jones to Denver to defend PBMs and their ability to help employers control soaring prescription drug costs.
Scott Woods, a representative for the Pharmaceutical Research and Manufacturers of America, will talk about how drug makers see PBMs.
John Kurzman will explain why the National Community Pharmacists Association wants regulators to rein in PBMs.
The association’s concerns include problems with getting into the PBMs’ pharmacy networks, prior authorization headaches and retaliatory audits, according to a copy of a slide deck. included in an NAIC meeting packet.
“Steering to PBM-owned retail, mail-order or specialty pharmacies leaves patients with little control over health care decisions,” according to Kurzman’s slide deck
Partly because of PBMs’ moves, many independent pharmacies are closing, and one in four neighborhoods is considered a pharmacy shortage area, Kurzman says.
The backdrop: Kurzman notes that state lawmakers have introduced about 225 PBM bills this year.
California Gov. Gavin Newsom vetoed a PBM regulation bill in September.
Pennsylvania Gov. Josh Shapiro signed a PBM bill in July. The Pennsylvania bill will require PBMs to register with the Pennsylvania Insurance Department every two years and prohibit PBMs from steering patients toward their own pharmacies.