Pandemic Complicates, Doesn’t Stop Push to Lower Drug Costs

With a presidential election looming and the COVID-19 pandemic still raging, it might stand to reason that drug pricing reform efforts would be on the backburner. However, there are indications that policymakers remain focused on initiatives that could have tangible business impacts for insurers, PBMs and drug manufacturers. Furthermore, legal battles over those initiatives are continuing to play out — including one case slated for Supreme Court review in the fall.

That case, Rutledge v. Pharmaceutical Care Management Association, concerns PCMA’s challenge to a 2015 Arkansas law that requires PBMs to reimburse pharmacies at or above their wholesale cost for generic drugs (RDB 8/21/15, p. 7). The trade group argues that PBMs should be exempt from such regulation by states, as they act as agents under the Employee Retirement Income Security Act of 1974. After split decisions in the lower courts, the Supreme Court agreed to hear the case, which experts have told AIS Health has far-reaching consequences for state efforts to regulate PBMs. Hearings are now scheduled for October after being delayed due to the COVID-19 pandemic.

© 2024 MMIT
Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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