PBM

Pharmacy benefit managers switched to virtual audits during the pandemic, which increased reviews, payment denials and their profits.

HB 2388 makes a previous law regulating PBMs more effective and gives state regulators the ability to police bad actors who violate the law.

House Bill 2388 will strengthen the existing regulation of pharmacy benefit managers by giving the Department of Consumer & Business Services the ability to investigate complaints and cancel a company’s registration if the PBM commits fraud or fails to pay civil penalties.

Pharmacists complain that they’re still at the mercy of wildly unpredictable and unfair compensation from some pharmacy benefit managers, and face burdensome audit and appeals processes to fix unfair pricing, despite a 2013 law intended to correct PBM behavior. They want the Insurance Division to have more teeth to enforce the law as well as new rules that would not allow PBMs to pay pharmacists less than their posted price.