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Unanimous Supreme Court decision is a blow to PBMs and the insurers that own them

On December 11, Healthcare Dive covered the U.S. Supreme Court’s decision upholding Arkansas’s regulations on pharmacy benefit managers.

In 2015, Arkansas passed a law prohibiting pharmacy benefits managers (PBMs) from reimbursing pharmacies less than what it cost to acquire a drug. The law was challenged by the PBM lobbying group Pharmaceutical Care Management Association, and recently the U.S. Supreme Court struck a blow to the PBM lobby by upholding the law. On the surface, this story is about one state standing up to PBMs profiting off the expense of pharmacies and consumers. On a deeper level, it is also a cautionary signal to the insurance companies that own these PBMs. Upholding a law that says PBMs can’t pay pharmacies less than what it costs them to acquire a drug seems like common sense, but unfortunately, it is necessary for protection. The parallels of the issue are similar to the plight of healthcare providers—except there aren’t protections for providers that make payors reimburse them at or above the cost of providing care. We’ll see how many other states follow Arkansas’ model to make sure that insurance companies are paying their fair share.

Original Article:

The unanimous 8-0 decision against pharmacy benefit manager lobby PCMA could lead to other states regulating PBMs in ways similar to a 2015 Arkansas law that prevailed in this case.

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