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Pharmacy Benefit Managers (PBMs) have been under investigation recently. PBMs negotiate rebates with drug manufacturers on behalf of a health insurance plan. Earlier this year, California sued several PBMs and drugmakers for allegedly overcharging on insulin, claiming that manufacturers artificially increased prices and PBMs received a larger rebate.
The U.S. House Oversight and Accountability Committee is investigating PBMs, in response to tactics some allege to be anti-competitive. They are probing for information related to PBMs’ role in rising health care costs and government health care programs. A report of findings and recommendations for potential legislation will be created once the probe is done.
The Federal Trade Commission (FTC) has also been looking into PBMs. They are analyzing some of the largest PBMs and analyzing their fees and rebates that are paid to them. This investigation is ongoing.
As PBMs face more scrutiny, employers should continue to monitor spending, utilization, and prescription drug trends. Download the bulletin for more details.
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
