Studies in states across the country have revealed that PBMs are overcharging taxpayers for their services, reimbursing pharmacies low for medications dispensed, billing the state Medicaid program high for the cost of those medications, and retaining the difference, called "spread." Additionally there have been issues with PBMs reimbursing pharmacies below acquisition cost, steering patients to pharmacies owned by or affiliated with PBMs, and other anticompetitive behaviors.
Also pursuing legislative solutions to further prevent PBM overreach,
In its comments, NCPA is urging the state (https://ncpa.org/sites/default/files/2021-07/NCPA-comments-auditing-entities-pbm-rule.pdf) to specify that pharmacy reimbursement should be inclusive of all fees, clawbacks, etc. that a PBM charges a pharmacy and that net reimbursement cannot be lower than the acquisition cost and required dispensing fee. NCPA is also pushing for language giving more flexibility to enforce the law's provisions against ERISA plans to the full extent allowed by federal law and federal decisions such as Rutledge v.
"Time and time again we see PBMs manipulate the health care system to evade scrutiny, skirt reforms or maximize profits, so laws and regulations to rein them in need to be as thorough as possible," said