Magazine article Drug Topics

Pressure Mounts for Licensing of PBMs

Magazine article Drug Topics

Pressure Mounts for Licensing of PBMs

Article excerpt

Pharmacy benefit management firms, which handle more than $100 billion a year in claims for 150 million patients, are coming under the increased attention of state regulators. Late last month, the National Association of Boards of Pharmacy recommended to states that they license PBMs just like pharmacies. NABP drafted model legislative language and will lobby state lawmakers for its enactment. "It will be up to the states to decide whether to license PBMs," Carmen Catizone, NABP executive director, told Drug Topics.

A pharmacist responding to the licensing question in a Drug Topics online forum posted this view: "If they want to make therapeutic decisions regarding what drugs should be used in their patients, then they should be subject to licensing. Contrary to what they say, this is a form of practicing medicine, and they should be held accountable, just as pharmacists and prescribers are."

In addition to NABP, the National Association of Insurance Commissioners is studying how states currently deal with PBMs. NAIC wants to determine "if a more formal regulatory framework is warranted." Its plans call for completion of the study by December in time for its winter meeting, where a decision could be made on going forward with model legislative language.

Groups representing PBMs and some of the 9,000 R.Ph.s who work for them are not happy with the prospects of licensing by state pharmacy boards and/or regulatory oversight from state insurance commissioners. "PBMs are complex business structures," said Judith Cahill, executive director of the Academy of Managed Care Pharmacy, which represents some 4,700 pharmacists. While some activities clearly constitute the practice of pharmacy and already are covered by state boards, she said, most of what PBMs do is not pharmacy. "Pharmacists acting as pharmacists-that's fine," she continued. "Regulating the PBM entity, then we get into less clear waters."

Delbert D. Konnor, president of the Pharmaceutical Care Management Association, does not believe PBMs need more oversight. "We feel PBMs have enough licensing and regulatory agencies watching them," he said. He mentioned state pharmacy boards; the Drug Enforcement Administration; and for one of PCMA's 35 members owned by an insurance company, a state insurance commissioner. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.