Pharmacy Benefit Manager Model Legislation and Resources

NASHP’s Center for State Rx Drug Pricing has developed model legislation that allows states to define new standards for pharmacy benefit manager (PBM) business practices. This model bill addresses PBMs’ fiduciary responsibilities and bans PBM gag clauses that prevent pharmacists from sharing lower cost drug options with consumers.

Pharmacy Benefit Manager Model Legislation A: This model legislation enables states to directly regulate PBMs, and gives states flexibility to identify which agency should oversee PBMs.

Pharmacy Benefit Manager Model Legislation B: This PBM model legislation allows states to regulate PBMs through their state insurance departments. It is modeled after 2019 Montana Senate Bill 71.

Chart Comparing PBM Models A and B: This chart provides a side-by-side comparison of provisions in NASHP’s Model A legislation and Model B legislation.

Montana Explores a New Approach to Regulating Pharmacy Benefit Managers: This blog highlights Montana’s approach to address PBM business practices by leveraging its insurance department’s regulatory authority over insurance carriers.

Pharmacy Benefit Manager Questions and Answers: Commonly asked questions and answers about PBMs’ role in the drug supply chain and NASHP’s model legislation.

How Legislation Helps States Shed Light on Pharmacy Benefit Manager Operations: This blog explores how states can use this model legislation to license PBMs, ban gag clauses that prevent pharmacists from sharing lower-price drug options with consumers, and require more transparency into exactly who profits from rebates.

Chart Comparing Pharmacy Benefit Manager laws in 21 states. States took varied approaches to regulating PBMs in 2018. This chart details each state’s approach and how their laws compare with NASHP’s PBM Model Legislation A.

NASHP’s Center for State Rx Drug Pricing develops model legislation to help states control rising prescription drug costs, and features the bills on its website. State officials interested in these model bills should contact Jennifer Reck for more information.

NASHP is continuing to research state legislative and administrative actions to control pharmaceutical costs. Check the resources listed below for updated information.

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