Pharmacy Benefit Managers.

Format:

Book

Author/Creator:

Cline, Pamela S.

Series:

Management Science - Theory and Applications Series

Language:

English

Subjects (All):

Pharmacy management.

Prescription pricing.

Physical Description:

1 online resource (239 pages)

Edition:

1st ed.

Place of Publication:

New York : Nova Science Publishers, Incorporated, 2024.

Summary:

This book explores the role and impact of pharmacy benefit managers (PBMs) within the prescription drug market. It examines their key functions, regulatory frameworks, and the economic dynamics that have led to their current market dominance. Initially, PBMs improved the healthcare system by providing transparency and reducing drug costs through competition. However, the consolidation of the market has resulted in three major PBMs controlling 80% of the market, leading to concerns about increased healthcare costs and reduced competition. The book provides an overview of relevant federal and state laws governing PBMs and discusses the implications for patients, healthcare providers, and policymakers. It is intended for professionals and stakeholders in the healthcare sector, as well as policy analysts and regulators. Generated by AI.

Contents:

Intro

Contents

Preface

Chapter 1

The Role of Pharmacy Benefit Managers in Prescription Drug Markets. Part I: Self-Interest or Healthcare?(

Statement of Miriam Atkins, M.D., Facp, AO Multispecialty Clinic, Augusta Oncology, P.C. President, Community Oncology Alliance

Statement of Greg Baker, B.S. Pharm, CEO of Affirmed RX

Statement of Kevin J. Duane Pharm D, Owner Panama Pharmacy

Statement of Frederick Isasi, J.D., M.P.H. Executive Director, Families USA

Chapter 2

The Role of Pharmacy Benefit Managers in Prescription Drug Markets. Part II: Not What the Doctor Ordered(

Statement of "JC" Scott President and CEO, Pharmaceutical Care Management Association (PCMA)

Statement of Lori Reilly Chief Operating Officer PhRMA

Statement of Craig Burton, Executive Director, Biosimilars Council, Senior Vice President, Association for Accessible Medicines

Statement of Hugh Chancy, RPH President, National Community Pharmacists Association (NCPA)

Statement of Rena M. Conti Ph.D. Associate Professor Department of Markets Public Policy, and Law Questrom School of Business

Chapter 3

Prescription Drugs: Selected States' Regulation of Pharmacy Benefit Managers(

Why GAO Did This Study

What GAO Found

Abbreviations

Background

Overview of Private, Employer-Sponsored Health Coverage

Regulation of Private, Employer Sponsored Health Coverage and PBMs

Overview of Prescription Drug Spending Trends

Private Health Plans' Use of PBMs

Duty of Care Provisions and Fiduciary Duty

States We Reviewed Have Enacted a Variety of Laws to Regulate PBMs

Four of Five Selected States Imposed a Duty of Care on PBMs, but States Took Different Approaches

Selected States' Requirements for PBMs on Drug Pricing and Pharmacy Reimbursement, Transparency, and Access.

Drug Pricing and Pharmacy Reimbursement Requirements

Transparency

Networks and Access

Stakeholders Expressed Mixed Views on Selected State Actions to Regulate PBMs

Stakeholder Views on a Duty of Care Requirement for PBMs

Stakeholder Views on PBM Laws Related to Pricing, Transparency, and Access

State Regulators Identified Lessons Such as Providing Broad State Regulatory Authority and Robust Enforcement Powers

Importance of Broad Regulatory Authority

Robust Enforcement

Reducing Ambiguous or Fragmented Authority

Clarity and Precision in Requirements

Information on PBMs across Different Kinds of Plans

Agency Comments

Appendix I: Stakeholders Interviewed by GAO

Appendix II: Stakeholders Views on Areas of State Pharmacy Benefit Manager (PBM) Regulation in Five Selected States

Stakeholder Views on PBM Laws Related to Drug Pricing and Pharmacy Reimbursement

Stakeholder Views on PBM Laws Related to Transparency

Stakeholder Views on PBM Laws Related to Pharmacy Networks and Access

Appendix III: GAO Contact and Staff Acknowledgments

GAO Contact

Staff Acknowledgments

Chapter 4

Pharmacy Benefit Managers: Current Legal Framework(

Introduction to PBMs

State Law Regulation of PBMs

State PBM Regulation and Federal Preemption Challenges

FTC Action Related to PBMs

Considerations for Congress

Disclaimer

Index

Blank Page.

Notes:

Description based on publisher supplied metadata and other sources.

Part of the metadata in this record was created by AI, based on the text of the resource.

ISBN:

9798895302255

OCLC:

1467877301