States Gain Power to Regulate PBM Rate Reimbursements, Supporting Independent Pharmacies

With the 2020 Supreme Court ruling, Rutledge v. Pharmaceutical Care Management Association, states have gained power to require PBMs to reimburse pharmacies for drugs at a rate equal to or higher than the pharmacies’ wholesale cost. The unanimous 8-0 opinion stated that a precedent-setting Arkansas law to regulate PBM practices is not preempted under ERISA; states may in fact enact laws that regulate PBM reimbursement costs to pharmacies.

With 47 attorneys general already backing states’ power to enact such laws, regional and independent pharmacies may finally see long-sought protections from “predatory reimbursement practices by PBMs,” according to a recent whitepaper by Frier Levitt law firm.

You view the entire whitepaper here.

Call us at Sykes & Company, P.A. for guidance about your third-party reimbursement rates and methods to improve your pharmacy’s margins.

You may be interested in our recorded webinar with special guest, attorney Jesse C. Dresser, Esq., about PBM and payer reimbursement trends.