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.

© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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