Pharmacy Benefit Managers (PBMs), the middlemen that negotiate rebates and manage drug benefits for health plans, businesses and government programs, bill themselves as saving money for government and the private sector, but their record is a checkered one. NLARx is working with state legislators to enact laws establishing transparency, anti-kickback, conflict of interest and other ethical standards for PBMs, which have been targeted in numerous fraud cases and other litigation. The First Circuit Court of Appeals upheld the Maine law, the first such state law to be enacted, in a broad decision, finding it does not impermissibly step on the jurisdiction of the federal government, whether under the ERISA law or constitutional provisions regarding interstate commerce, protection of property (trade secrets) or free speech, and the Supreme Court has refused to review this holding.

Researching this Issue

Model state PBM laws and best practices, testimony supporting these initiatives, and background information and research materials including reports, legal briefs and decision, and news articles are posted here. Information on PBM fraud litigation is posted on the Medicare & Medicaid issue page. The Pharma Watch page is also a good resource for information on how the PBM industry markets itself. See also the Related Links below to connect to other organizations and materials with relevant information on this issue.


Model Legislation
Nov 20, 2008
Phamacy Benefit Manager (PBM) Transparency and Fiduciary Standards | >>more
Jan 28, 2008
Model Conflict of Interest Disclosure Form and Agreement | >>more
Dec 14, 2007
HR Policy Association PBM Transparency Model Standards | >>more
>> view all Model Legislation
 
Testimony
Apr 15, 2009
Change to Win Testimony in Support of Maine PBM Legislation | >>more
Feb 21, 2008
Joint Hearing by the Texas House Government Reform and Pensions and Investments Committees | >>more
Nov 09, 2007
Should pharmacies be allowed to collectively negotiate with PBMs? Testimony of David Balto | >>more
>> view all Testimony
 
Legal Briefs and Opinions
Jul 12, 2010
Decision PCMA v. District of Columbia, DC Court of Appeals | >>more
Feb 22, 2008
Final Ruling in Madigan v. Caremark | >>more
Oct 26, 2006
Ongoing Federal & State PBM Litigation | >>more
>> view all Legal Briefs & Opinions
here
Related News
Jul 23, 2010
AIS Health
CVS Caremark, Walgreens Mend Fences with New Network Deal | >>more
Jul 22, 2010
The Street
Health Care Losers: Medco and Express Scripts | >>more
Jul 20, 2010
Government Executive
Pharmacists back measures to cut feds' prescription drug costs | >>more
>> view all News
 
Reports
Oct 09, 2009
NLARx, the Consumer Federation of America, and US PIRG Letter to Sen. Reid Supporting PBM Transparency | >>more
Mar 10, 2009
Tufts Study: 75% of U.S. Health Plans Reimburse for Off-Label Uses of Prescription Drugs | >>more
Feb 18, 2009
Rx Action in the States, 2009 | >>more
>> view all Reports
 
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