It’s a ‘battle’: Pharmacy groups file PBM court brief

ALEXANDRIA, Va. – Four pharmacy groups, including the National Community Pharmacists Association, filed a court brief this week in support of a Louisiana law requiring pharmacy benefit managers administering Medicare Part D plans to reimburse pharmacies a 10-cent provider fee. 

The case, Louisiana Independent Pharmacists Association v. Express Scripts, is the first test of a recent decision by the 8th Circuit Court of Appeals that allows North Dakota and other states in the jurisdiction to regulate PBMs. Express Scripts, owned by Cigna, is one of the three largest pharmacy benefit managers in the country, collectively controlling nearly 80% of all prescriptions, according to the NCPA. 

“Consumers and independent pharmacies have been subjected to the enormous market leverage PBMs, and now their health insurance plan owners, exert to drive small pharmacies out of business with unfair practices like the ones on display in Louisiana,” Doug Hoey, NCPA CEO and pharmacist. “NCPA has been fighting them in court for many years. The Supreme Court decision was a major breakthrough, and now pharmacies and consumers are in a 50-state battle that we aim to win. NCPA is proud to support our members in the 5th Circuit who will be directly affected by this decision.” 

In December 2020, the U.S. Supreme Court ruled unanimously in Rutledge v. PCMA that Employee Retirement Income Security Act of 1974 (ERISA) does not prohibit states from regulating PBMs. In November 2021, the 8th Circuit Court of Appeals affirmed the Supreme Court’s decision in PCMA v. Wehbi and confirmed that in some circumstances states may regulate PBMs in Medicare Part D.