AMA recommends oversight of TPAs
By HME News Staff
Updated 9:51 AM CST, Wed November 16, 2022
HONOLULU – The American Medical Association decided at its interim meeting here to recommend that third-party administrators of specialty pharmacy benefits be included in state and federal oversight efforts of prescription drug middlemen. Regulation of pharmacy benefit managers is on the rise in response to concerns that they can have a detrimental impact on the ability of patients to access affordable prescription drugs and, for specialty pharmacy benefits, TPAs provide many of the same services, including developing and maintaining formularies, processing claims, and negotiating discounts and rebates between payers and manufacturers “Given that TPA services can have a negative impact on access and affordability for specialty drugs, the AMA will remind state and federal regulators not to ignore TPAs in their oversight of drug middlemen,” said AMA Board Member Marilyn Heine, M.D. “Specialty drugs are often a critical part of a patient’s care for cancer, certain forms of arthritis, and other medical conditions. As such, the AMA believes TPAs should be subject to the same licensing, registration, and transparency reporting requirements that regulators mandate for PBMs.”
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