Yesterday in MedPage Today, Marsha was cited for her thoughts on the current Supreme Court case involving state regulation of pharmacy benefit managers (PBMs). Namely, this case involves a 2015 Arkansas law requiring PBMs to pay back pharmacies at or above the cost the latter pay to obtain the drugs in the first place, and giving pharmacies a right to appeal PBM reimbursement rates. It’s considered a test case for managing PBM reimbursement rates, as many other states have sought to regulate PBMs’ conduct. At issue is whether federal law, specifically the Employment Retirement Income Security Act (ERISA), preempts state law when a state begins to deal in rate settings.
Specifically, Marsha said she agrees with the appeals court ruling in favor of PBMs. It wouldn’t necessarily be “a bad outcome” for advocates of the Arkansas law, she said, because it would underscore the need for federal legislation. “Similar decisions have in the past created momentum for federal health care reform,” she noted. One example is the Affordable Care Act, which replaced an insurance “patch-work” with standardized regulation.
“Broadly, I come down on the side of the PBMs and the health plans until we have comprehensive drug pricing legislation. The PBMs’ central purpose is to negotiate more favorable drug prices and generally restrain the costs of drug benefits and they have done a decent, while not perfect job,” Simon said.