Attorney General Jason Miyares has joined 34 other attorneys general in an amicus brief supporting Oklahoma’s laws regulating pharmacy benefit managers (PBMs). Miyares’ press release said Virginia’s laws are similar to Oklahoma’s, and the regulations are necessary to protect consumers and pharmacies against PBMs, which act as middlemen between insurance providers, pharmacies, and drug manufacturers.
“Virginians’ healthcare costs continue to rise, and PBMs are partially to blame. Virginia has enacted laws to protect consumers from abusive PBM practices—including laws I supported in the General Assembly. Now, as your Attorney General, protecting consumers is one of my most important jobs, and I will continue to fight for these laws and the consumers they protect,” Miyares said.
PBMs negotiate drug costs, contract with pharmacies, and process and pay prescription drug claims. Some are also affiliated with major pharmacies.
“PBMs profit from fees charged to market participants and by reimbursing pharmacies less than the PBM is paid by plans for dispensing medications. PBMs have imposed self-serving protections that reduce competition, limit prescription medication access, and impose various confidentiality requirements,” Miyares’ release states.
The release additionally states that PBMs can use preferential rates to funnel consumers to PBM-affiliated pharmacies, potentially harming independent pharmacies.
The Pharmaceutical Care Management Association, a trade association, is suing Oklahoma’s Insurance Department over the Oklahoma’s Patient’s Right to Pharmacy Choice Act, one of several PCMA lawsuits over PBM laws.
“Oklahoma requires PBM’s pharmacy networks to have sufficient geographic coverage, allow all in-network pharmacies to receive preferred-participation status if they meet the PBM’s criteria for that status, prohibit network exclusion solely because a pharmacy employee may be on probationary status, and prohibit PBMs from incentivizing the use of particular (typically PBM-affiliated) in-network pharmacies,” Miyares’ release states.
The lawsuit has been appealed up to the U.S. Court of Appeals for the Tenth Circuit, with PCMA arguing that federal law preempts the Oklahoma regulation. The final ruling in the case will impact the legality of similar laws in other states.
The attorneys general’s brief states, “The states have an interest in preserving states’ authority to regulate companies doing business in their states, protecting their residents’ access to healthcare, and curbing abusive business practices. To advance these interests, nearly all states regulate pharmacy benefit managers. Appellant’s sweeping approach to ERISA and Medicare preemption would severely impede states’ abilities to protect their residents and potentially upend licensing and regulatory structures in nearly every state.”
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