Supreme Court Rules in Favor of Pharmacists, Patients: Decision Validates Texas Efforts to Rein in PBMs

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The Texas Pharmacy Association says yesterday's unanimous Supreme Court decision empowers states like Texas to take action to hold pharmacy benefit managers (PBMs) accountable for their role in managing drug benefits that profit at the expense of local pharmacists, pharmacies and the patients who depend on them.

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This ruling removes a significant barrier in providing patients with access to their pharmacy of choice and increased price transparency. This is a big win for our pharmacies, pharmacists, and patients.

The Supreme Court of the United States yesterday issued its landmark decision in Rutledge v. Pharmaceutical Care Management Association (PCMA), ruling in favor of an Arkansas law to prevent abusive pharmacy benefit manager (PBM) payment practices.

The unanimous decision empowers states like Texas to take action to hold PBMs accountable for their role in managing drug benefits that profit at the expense of local pharmacists, pharmacies and the patients who depend on them.

“This ruling removes a significant barrier in providing patients with access to their pharmacy of choice and increased price transparency,” said Texas Pharmacy Association President Michelle Beall, Pharm.D. “This is a big win for our pharmacies, pharmacists, and patients. But, there’s much more work to do to in Texas to strengthen PBM regulations to benefit patients during the upcoming 2021 legislative session.”

PBM reform is a top legislative priority for the Texas Pharmacy Association and its recently formed Independent Pharmacy Academy, which aims to strengthen and unite the voice of independent pharmacy in Texas.

Texas is one of 46 states whose attorneys general signed on to an amicus brief this spring, telling the high court that preserving states’ ability to regulate PBMs was essential for curbing harmful business practices in healthcare and protecting consumers' access to medication.

The Arkansas law upheld by the Supreme Court this week prohibits PBMs from reimbursing local pharmacies at a lower rate than what the pharmacies pay to fill prescriptions. PBMs often profit by reimbursing pharmacies at less than a pharmacy’s cost to acquire a drug. This is just one of the many ways the PBM system puts pharmacies and patients at a disadvantage.

PBMs determine which pharmacies will be included in a prescription drug plan's network and how much those pharmacies will be paid for their services. PBMs also regulate which drugs are covered under a specific plan and set copays, negotiate rebates with drug manufacturers, and incentivize patients to use mail order and specialty pharmacies owned by the PBMs. Acting as middlemen, the role of PBMs can go largely unnoticed, leading to hidden costs and higher drug prices.

“This is a historic decision for the thousands of pharmacy professionals who play a critical role in ensuring public health,” said TPA Chief Executive Officer Debbie Garza, R.Ph. “Texas pharmacists remain on the front lines of the coronavirus pandemic, not only providing much-needed medication but also keeping their patients safe and healthy by providing COVID-19 testing and soon COVID-19 vaccinations. It is critical that Texas rein in PBM practices to ensure patients have access to their local pharmacies and we let pharmacists do what they do best: serve their patients and their communities.”

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Debbie Garza, R.Ph.
@TXpharmAssn
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