Visante was commissioned by the Pharmaceutical Care Management Association (PCMA) to
estimate the potential cost impact of four types of state legislation impacting pharmacy benefit
management (PBM) tools: PBM disclosure mandates, PBM fiduciary mandates, limits on prior
authorization (PA) and step therapy (ST), and any willing specialty pharmacy requirements.
As a general rule, such state legislation would affect only plan sponsors for commercial, fully
insured plans. These plans provide prescription drug benefits to an estimated 77 million
Americans. To make our estimates, we conducted a comprehensive review of the published
evidence on how much PBM tools save as they are currently used in the marketplace and
created an economic model of the impact of legislative proposals on the use of these tools and
the resulting impact on projected drug expenditures for the fully insured commercial market for
the next 10 years.
Proposals to restrict the use of PBM tools limit options that plan sponsors can use to manage
their drug benefit costs. Some legislation may prohibit the use of a PBM tool entirely, driving
savings to zero. Other legislation may negatively affect the full use of PBM tools and compress
the range of savings achieved in the marketplace. We modeled how the savings from those
tools would be reduced and how projected drug expenditures might increase over the next 10
years as a result.
