Pharmacists cheer ‘historic victory’ against pharmacy benefit managers
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Several pharmacy associations applauded a recent Supreme Court decision regarding how much pharmacy benefit managers reimburse pharmacies for the cost of drugs covered by employer-sponsored health plans.
Arkansas, Texas and 44 other states argued to the court that they — not the federal Employee Retirement Income Security Act of 1974, or ERISA — should regulate PBMs to avoid “harmful business practices in health care and protecting consumers’ access to medication,” a press release from the Texas Pharmacy Association said.
The Supreme Court unanimously ruled last month in favor of an Arkansas law that requires PBMs to reimburse pharmacies for drugs at a price that is “equal to or higher than” the wholesale cost, saying the state law is not preempted by the federal law.
“This is a historic victory for independent pharmacies and their patients,” B. Douglas Hoey, MBA, a pharmacist and CEO of the National Community Pharmacists Association, said in a press release.
The ruling increases drug pricing transparency and pharmacy access for patients and improves freedom of choice and health care for patients, the Arkansas Pharmacists Association said in a press release.
Conversely, the Pharmaceutical Care Management Association (PCMA) said in a statement that it was “disappointed” in the Supreme Court decision, claiming it undoes federal protections under ESIRA. The PCMA also said ERISA helps secure “access to affordable, quality prescription drug coverage” and that giving reimbursement power to the states will “create an unworkable patchwork of regulation around prescription drug benefits.”
“As states across the country consider this outcome, we would encourage they proceed with caution and avoid any regulations around prescription drug benefits,” PCMA said.
References:
- National Community Pharmacists Association. Battleground: SCOTUS. https://ncpa.org/scotus. Accessed December 29, 2020.
- Pharmaceutical Care Management Association. PCMA statement on U.S. Supreme Court decision in Rutledge v. Pharmaceutical Care Management Association (PCMA). https://www.pcmanet.org/pcma-statement-on-u-s-supreme-court-decision-in-rutledge-v-pharmaceutical-care-management-association-pcma/. Accessed December 29, 2020.
- Pharmaceutical Care Management Association. PCMA defends access to affordable, high quality health plans for American job creators, employees and patients at Supreme Court. https://www.pcmanet.org/pcma-defends-access-to-affordable-high-quality-health-plans-for-american-job-creators-employees-and-patients-at-supreme-court/. Accessed January 1, 2021.
- Texas Pharmacy Association. Supreme Court rules in favor of pharmacists, patients: Decision validates Texas efforts to rein in PBMs. https://www.prweb.com/releases/supreme_court_rules_in_favor_of_pharmacists_patients_decision_validates_texas_efforts_to_rein_in_pbms/prweb17609552.htm. Accessed December 29, 2020.
- U.S. Supreme Court. Recent decisions. https://www.supremecourt.gov/. Accessed December 29, 2020.
Perspective
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C. Michael White, PharmD, FCP, FCCP
The benefits of Arkansas winning this case in the Supreme Court, particularly increased pharmacy access and price transparency, become clear when we look at the impact that PBM contracting has on patient outcomes.
Since widespread PBM consolidation has occurred, reimbursements to community pharmacies has diminished, increasing the number of prescriptions that need to be filled hourly and reducing the time a pharmacist must provide non-dispensing services to patients. With medication nonadherence being a huge national health issue, minimizing time for pharmacist-patient interactions is dangerous. If patients are being forced to use mail-order pharmacies for all chronic medications and only go to community pharmacies for prescriptions for new drugs, they cannot develop a trusting relationship with their pharmacist. If they are steered to community pharmacies for a chain affiliated with the PBM, this puts unfair competition in the market for smaller pharmacies that have track records of providing more hands-on care. This reduces the depth of patient trust and makes health interventions more difficult and harder to detect medication adherence, drug interactions and adverse events.
Community pharmacies provide a safety net, especially for patients who have disparities in access to care. Vaccinations, counseling, detection of drug interactions and access to nonprescription drug products in community stores promote health and wellness.
References:
- KHN. https://khn.org/news/no-more-secrets-congress-bans-pharmacist-gag-orders-on-drug-prices/. No more secrets: Congress bans pharmacist ‘gag orders’ on drug prices. Accessed December 31, 2020.
- White CM. Ann Pharmacother. 2019;doi:10.1177/1060028019881692.
Perspective
Back to TopThis opinion unequivocally establishes that states can regulate PBMs without running afoul of ERISA. It will hopefully encourage states to rein in the abusive practices of the PBM industry for supply chain stakeholders beyond pharmacies as well. Since 45 other states and the District of Columbia supported Arkansas in the lawsuit, we are sure to see renewed enthusiasm from state legislatures on this topic, opening the door to improving access to pharmacies and appropriate, needed treatment for our patients.
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