Other states have regulated PBMs. Here’s how they fared.
While House Bill 246, which would regulate pharmacy benefit managers in North Carolina, has been locked in a Senate committee for more than a year, other states have imposed similar regulations and reported saving millions of dollars.
Rep. Wayne Sasser, R-Montgomery, one of the sponsors of HB 246, disputes the PBMs’ claim that regulating them would raise the cost of medications.
“The history of other states is contrary to that philosophy,” he said. In fact, in other states, “the cost of healthcare has actually come down for the patient, not gone up.”
Arkansas’ Act 900, passed in 2015, allows a pharmacy to challenge PBM reimbursements that are less than the amount it cost for the pharmacy to acquire the drug. The act was upheld by the U.S. Supreme Court in an 8-0 decision in 2020, setting precedent for states to regulate PBMs.
Kentucky enacted SB188 in 2024, ensuring that PBMs include pharmacies within a close distance of patients in their networks as long as pharmacies abide by reasonable terms.
The Washington State Healthcare Authority estimated that it saved $156.8 million in 2021 by eliminating spread pricing, where PBMs charge health plans more than they pay to pharmacies.
Kentucky and West Virginia started using one PBM, saving Kentucky’s Medicaid program $282 million in 2021 and 2022 and West Virginia’s Medicaid program an estimated $54.4 million in 2018.
On Feb. 20, 2024, North Carolina Attorney General Josh Stein joined a group of 39 attorneys general, sending a letter asking members of Congress to regulate PBMs.
This story was originally published September 12, 2024 at 5:00 AM.