Lawmakers across the country are trying to pull back the curtain on the processes pharmacy benefit managers use to negotiate drug prices, but it's unclear if mandating greater transparency from PBMs will result in patients paying less for their prescriptions, Kaiser Health News reported June 30.
In April, Montana passed a measure that will require PBMs to get a state license and publicly report how much money they receive, beginning in 2022. The measure also controls what information PBMs give to other companies when negotiating.
New York also passed a measure requiring PBMs to get a state license and publicly report the money they collect. Another example of PBM regulation, passed by Wisconsin lawmakers, brought PBMs under state oversight and required pharmacies to tell patients about cheaper prescription generics.
Lawmakers argue that mandating PBM transparency will lower prescription prices, but it probably won't be that simple.
"There’s really not a clear answer on what types of policies will necessarily bring down spending because you have to also ask the question of 'spending for who?'" Elizabeth Seeley, PhD, a healthcare payment systems expert from Cambridge, Mass.-based Harvard University, told Kaiser Health News.
Recent PBM regulations could result in reduced costs for stakeholders in the healthcare industry, such as insurers, rather than savings for patients. To enact meaningful change that will make medication more affordable for Americans, lawmakers would have to introduce legislation targeting drugmakers, likely at a federal level, Dr. Seeley said.