2021 Outlook: Chaotic Transition Complicates Regulatory Landscape for PBMs

In the year ahead, Trump administration drug pricing policies are likely to be changed or revoked by the incoming Biden administration and court challenges, although which policies will be affected — and to what extent — is still unclear, policy experts tell AIS Health. Meanwhile, the violent attack on the Capitol by supporters of President Donald Trump may have poisoned bipartisan efforts to reform drug pricing before Congress had a chance to take them up.

These uncertainties are a challenge for PBMs, according to experts. Brian Anderson, a principal at Milliman Inc., observes that firms have to act as though they will need to comply with the Trump administration’s rules, even if there is consensus that the new administration will make changes. Anderson also notes that PBMs and plans are managing the transition amid the most challenging plan year rollover in recent memory.

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