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Updated: Sep 2, 2025

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State-level policy efforts to regulate pharmacy benefit managers (PBMs).

T Joseph Mattingly1, Maisie Lewis2, Mariana P Socal3

  • 1University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.

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Pharmacy Benefit Managers (PBMs) manage prescription drug benefits. State regulations aim to increase transparency and accountability, but their impact on patient health and costs remains unproven.

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Area of Science:

  • Health Policy
  • Pharmaceutical Economics
  • Healthcare Management

Background:

  • Pharmacy Benefit Managers (PBMs) emerged in the 1960s to manage prescription drug benefits for insurers.
  • PBMs have expanded their role in the drug supply chain, leading to increased scrutiny and state-level regulation.
  • As of November 2021, all 50 states have implemented regulations targeting PBM operations.

Purpose of the Study:

  • To analyze the focus and potential impact of state-level PBM regulations.
  • To evaluate whether current regulations ensure benefits translate to improved patient outcomes, cost savings, or enhanced provider experiences.
  • To examine the alignment of state policies with community pharmacist advocacy and their effectiveness.

Main Methods:

  • Review of state-level PBM regulations enacted up to November 2021.
  • Analysis of policy levers employed by state regulations.
  • Assessment of the evidence base supporting the claimed benefits of these regulations on patient health, costs, and provider experience.

Main Results:

  • State regulations often address business transactions between pharmacies and PBMs, influenced by community pharmacist advocacy.
  • Policies aim to enhance transparency, prevent anti-competitive practices, and increase PBM accountability to plan sponsors.
  • A lack of direct mechanisms exists to guarantee that regulatory benefits yield system-wide cost savings, improved health outcomes, or better quality of care.

Conclusions:

  • While state regulations on PBMs aim to improve transparency and accountability, their effectiveness in achieving broader healthcare goals is not substantiated.
  • Current policies may not ensure that potential benefits are realized as cost savings for consumers or improvements in patient health and care quality.
  • Further research is needed to establish direct links between PBM regulations and tangible improvements in the healthcare system.