The Supreme Court will hear your calls for greater PBM oversight

All APhA members need to know about a crucial effort by APhA, the National Community Pharmacists Associations (NCPA), Arkansas Pharmacists Association (APA), the National Alliance of State Pharmacy Associations (NASPA), and other pharmacy organizations: In the next few weeks, we will jointly submit an amicus curiae brief to the Supreme Court in Rutledge v. the Pharmaceutical Care Management Association.

In this case, the state of Arkansas will argue to allow the state to regulate pharmacy benefit managers (PBMs), which some lower courts have said is forbidden by federal law. If the Supreme Court rules in favor of Arkansas, states with PBM oversight laws similar to those of Arkansas would have clearer authority to regulate PBMs.

“Amicus curiae” literally translates to “friend of the court” and refers to legal briefs submitted by entities who are not party to the case at hand—APhA will not have any direct role in arguing the case. But, at the discretion of the Court, the justices can review amicus briefs to get more insight and expert opinion that could have bearing on the case.

The lack of PBM regulation hurts patients every day! As an organization for all pharmacists and all of pharmacy, APhA knows all too well the grim picture of what patients face when the pharmacies they have visited for years—often multiple times monthly—close because of abusive PBM practices like retroactive direct and indirect (DIR) fees and exclusion from preferred pharmacy networks. Together with our colleagues at APA, NCPA, and NASPA, we are dedicated to representing your voices. Your voices, which add context to the dire consequences of siding with PBMs, will be heard through the amicus brief.

As pharmacies are starved of fair and adequate reimbursements, patients lose access to a readily available, knowledgeable health care provider whose guidance can help them get the most out of their medications, avoid preventable illnesses, manage chronic diseases, and keep them out of the hospital or from returning to a hospital after discharge.

The ancillary benefit is lower costs to the health care system at large. When PBMs starve pharmacies, they starve patients and they starve taxpayers.

If Arkansas wins its case, and depending on the scope of the Court’s opinion, states could gain wider latitude to oversee PBMs and force them to be transparent about how they operate. The ruling would not end DIR fees or unfair reimbursement, but it could give states authority to determine whether these practices are detrimental to patients and public payers. Lower courts have been split on whether state PBM regulation is permissible under the Employee Retirement Income Security Act (ERISA).

If the state loses its case, the pharmacy community, including APhA, will go on fighting for alternate avenues to rein in PBMs and stop the madness that ultimately affects every single one of us.

There is a long way to go before this issue is settled. The Court has not yet announced a date for oral arguments, but it’s anticipated they’ll be heard in late April, with a ruling typically coming several months later. You'll have the chance to join your colleagues for a rally on the steps of the Supreme Court here in Washington, DC, so stay tuned for other ways you can get involved, the latest on the case, and how APhA is ensuring that your voice is heard.