Signed into law in April, the legislation will ban direct and indirect PBM ownership of pharmacies, effective Jan. 1, 2026. It addresses longstanding concerns about conflicts of interest, market consolidation and patient access created by vertically integrated PBM pharmacy models.
ACR Comments on Proposed Medicare Advantage Changes
In response to proposed changes to the Medicare Advantage and prescription drug programs for contract year 2026, the ACR submitted comments on the provisions related to the Inflation Reduction Act, prior authorization and the influence that pharmacy benefit managers have on the placement of biosimilars on formularies.
The Ethical Tug-of-War Over Biosimilar Adoption
The advent of biosimilar medications has offered the promise of significant cost savings for healthcare systems and patients. Biosimilars are highly similar versions of existing biologic drugs, providing a more affordable alternative once the original biologic patent expires. However, the adoption of biosimilars in the U.S. has been hampered by myriad roadblocks, many of which…
Pharmacy Benefit Managers Under Scrutiny
“When pharmacy benefit managers [PBMs] came into being 30 years ago, they were seen as an important component of the prescription distribution system [because] they could guide benefits and money between the patient, pharmacy and the manufacturer,” says Angus Worthing, MD, president of the Alliance for Transparent & Affordable Prescriptions (ATAP). Health insurance companies hire…
Slow but Steady: 2023 State Legislative Progress
This legislative season has seen key pharmacy benefit manager reforms but slow movement on other issues, such as copay accumulators and utilization management. The ACR is also monitoring emerging topics, such as biomarker testing and post-public health emergency telehealth reforms.
A Unique Partnership Gives the ACR a Voice in Insurance Legislation Development
A recent meeting of the National Council of Insurance Legislators (NCOIL) featured discussions of many topics important to ACR members, including pharmacy benefit manager legislation, biomarker testing and transparency in the healthcare market.
What to Expect in Healthcare Policy from the 2023 State Legislative Sessions
With 2023 state legislative sessions underway, early prevailing themes may forecast areas where we will see gains this year. Key issues include utilization management, copay accumulator bans, white bagging and pharmacy benefit manager reform.
ACR Leads AMA Resolution to Address Disruptive Practices of Pharmacy Benefit Administrators
At the AMA House of Delegates meeting in November, the ACR’s delegation will lead over a dozen cosponsoring specialties and medical associations in advancing a resolution addressing serious concerns about third-party pharmacy benefit administrators and the impacts of their disruptive practices.
Florida Law Puts Drug Pricing by Pharmacy Benefit Managers Under a Microscope Once Again
As of July 1, a Florida bill increases oversight of pharmacy benefit managers and offers some protection for pharmacies. However, the legislation has limited effects on patients and providers, highlighting the need for additional reform.
Trends in State White Bagging Legislation
The ACR is working with partners in several states to legislate against policies that require physicians to acquire provider-administered drugs through a preferred specialty pharmacy designated by a payer or pharmacy benefit manager.
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