The state of PBM regulation in the states

Ben Franklin on a bill, peering out through a lot of pills

It is widely understood – perhaps especially by benefits professionals, who see the direct impact on their medical and prescription drug plan offerings – that the cost of prescription drugs is on the rise. There seems to be less consensus, however, on what (or who) is causing the rise in prescription drug costs, but pharmacy benefit managers (PBMs) seem to have become a regular target lately for both litigation and regulation.

As their name implies, PBMs are third-party companies whose main role is to help manage the cost and delivery of pharmacy benefits. They generally serve as an intermediary between prescription drug manufacturers and insurance or benefits providers with the idea that PBMs are able to use their size and scale to deliver cost savings to their clients on prescription drugs.