Pharmacy Benefit Manager Legislation

ABI staff continues to work with members of the Senate on legislation (HF 2384) to reform the relationship between pharmacy benefit managers (PBMs) and the pharmacies they reimburse for prescriptions filled for participants in ABI member employee health plans. As mentioned in this column before, ABI staff sees a path to provide these state-based reforms that will provide more financial certainty for local independent pharmacies. Care must be taken not to drive up costs for employer sponsored health plans while doing so, and that is the focus of staff efforts.

Larger employers that fully self-fund their health plans have been federally regulated under the 1974 Employee Retirement Income Security Act (ERISA) and were at risk of new state regulations under the proposed law. We now expect clarification that ERISA plans will be exempt from the legislation if passed.