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Latest news and updates about the Medicare and pharmacy industries.

January 17: Supreme Court Will Hear PBM Regulation Case

Posted on in Industry Updates by Amplicare Team

Plus, the latest healthcare and pharmacy news to know this week

The Story

The Supreme Court has agreed to hear a case that could have implications for how much states can regulate PBMs. The case revolves around an Arkansas law that governs the rates PBMs reimburse pharmacies for generic drugs.

Why It Matters

Back in 2018, Arkansas’ Attorney General began an investigation into PBM practices after receiving complaints from pharmacists about reimbursement rates. The state ultimately sued some PBMs for violating Act 900, which prohibits PBMs from reimbursing pharmacies below the cost they paid to acquire medication. A federal appeals court ruled in favor of the PBMs and that case is now being moved up the ladder to the Supreme Court. 

PBMs have come under scrutiny in the past few years as communities and the government look for solutions to the high cost of drugs in the U.S. Last year, the Senate Finance Committee passed the Prescription Drug Pricing Reduction Act of 2019 in an attempt to provide more transparency and accountability in the supply chain. Among other things, the Act would require PBMs to publish annual reports on any rebates, discounts, or price concessions they negotiate for payers and reveal how much of the savings were passed on to payers. CMS also released new guidance targeting alleged spread pricing, which involves reimbursing pharmacies one price for prescriptions while charging plans another price.

As pharmacy groups look for reform on the rebate system and greater transparency, the Supreme Court’s decision will set an important precedent for the industry. 

Other important healthcare news to know:

1. Pharmacists are the fourth most trusted professionals, according to a new Gallup poll. Drug Topics.

2. States that expanded Medicaid saw a 6% decrease in total opioid overdose deaths compared to states that didn’t expand Medicaid. Health Payer Intelligence

3. Pharmacy owners are concerned about transfer requests from Amazon PillPack targeting their patients. Pharmacy Times.

4. The Michigan legislature approved a bill allowing for remote pharmacies. Daily Inter Lake.

5. Oklahoma settles another case against opioid manufacturers for $8.75 million. AP.

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