Government releases paper on selected states’ regulation of PBMs

States have adopted their own laws to regulate PBMs, according to a new report from the U.S Government Accountability Office (GAO).

The report focused on five states: Arkansas, California, Louisiana, Maine, and New York. Each of these states has enacted a broad range of legislation regarding PBMs serving private health plans.

GAO reviewed the laws and interviewed state regulators, state pharmacy associations, state health plan associations, and national organizations representing the interests of various stakeholders.

The report found that except for Arkansas, the other four states—California, Louisiana, Maine, and New York—have adopted laws imposing a duty of care on PBMs.

The laws range from requiring a fiduciary duty to “lesser” standards such as a requirement to act in “good faith and fair dealing.”

These states have enacted laws about drug pricing and pharmacy reimbursement requirements, transparency, and pharmacy network and access requirements.

In interviews, regulators from four states asserted that giving regulators broad regulatory authority was more effective than implementing specific statutory provisions, as this enabled regulators to address emerging issues without new legislation.

Some of the regulators also highlighted the importance of robust enforcement of PBM laws and penalties to enforce the measures, while others stressed that having clear reporting requirements and definitions had a positive effect on enforcement.