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GAO Report Highlights Common Themes in State PBM Regulations

A recent report by the U.S. Government Accountability Office (GAO) examines actions taken by state regulators in Arkansas, California, Louisiana, Maine, and New York to regulate pharmacy benefit managers (PBMs), offering insights into common themes and challenges. As states increasingly enact laws to regulate PBMs and many face legal challenges, the report serves as a valuable framework for PBMs, insurers, and plan sponsors to navigate compliance obligations in this rapidly evolving legal landscape. Click here for article.

  • The GAO report highlights common themes in state PBM laws, including the imposition of fiduciary or "duty of care" requirements on PBMs in four of the five reviewed states.

  • All five states have enacted laws related to drug pricing and pharmacy reimbursement, with measures aimed at limiting spread pricing and increasing transparency in PBM operations.

  • Transparency requirements, such as licensure and reporting mandates, are a common feature of PBM regulations in all five states, aiming to enhance oversight of PBM activities.

  • Pharmacy network and access requirements, including prohibitions on discrimination against unaffiliated pharmacies and limits on patient co-pays, are addressed in laws enacted by all five states.

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