PBM Audits Infographic (2023)

A PCMA infographic explaining the type of audits, value of audits, and examples of fraud, waste, and abuse.

WI LRB 1933 Comment Letter (2023)

Comment Letter circulated to legislators addressing WI LRB 1993, a copay accumulator bill.

MN HF 294 Comment Letter: Frozen Formulary (2023)

A comment letter on MN HF 294, a bill that would limit the ability to make formulary changes during a plan contract term such as setting prior notice requirement for notifying pharamices of formulary changes, and adds criteria for moving drugs to higher tier.

WV SB 267 Comment Letter: Gold Carding, Prior Authorization (2023)

A comment letter addressing WV SB 267.  The comment letter addressess concerns with decreasing the prior authorization approval threshold for practitioners to be “gold carded”, and proposed changes to the require response time to a prior authorization request.

Explainer: What Is a PBM Pharmacy Audit (2023)

Explains the types of pharmacy audits, and various reasoning for pharmacy audits being conducted.

Pharmacy Audits Protect Consumers (2023)

An explainer on the value of pharmacy audits.

Explaining White Bagging (2023)

High level overview document explaining what white bagging is.

Benefits of White Bagging (2023)

Includes messaging of the benefits of White Bagging

OK BoP Proposed Rule–Chapter 15 Comment Letter (2023)

A comment letter PCMA submitted to the OK Board of Pharmacy regarding the Boards Proposed Rule, specifically the Chapter 15 Draft Rules on the physical requirements for certain prescription drug packaging and shipping methods as conducted by non-resident pharmacies.

NJ S. 3480/S. 2824 Comment Letter (2023)

This comment letter adddresses S. 3480/S. 2824, which among other things, limits the use of step therapy in the small group market.

Pharmacy Audits White Paper (2023)

New white paper reviews the value of pharmacy audits conducted and provides analysis on effectiveness of identifying for fraud, waste, and abuse.

White Paper: The Return on Investment on PBM Services (2023)

White Paper: PBMs Generating Savings for Plan Sponsors and Consumers (2023)

White Paper: Increased Costs Associated with State Legislation Impacting PBM Tools (2023)

PBMs Save Employers and Patients 100B Per Year on Drug Costs Infographic (2021)

PBM Tools Save in Seven Ways Infographic (2020)

PBM Industry Principles (2021)

One Pager, Study Confrims Value of PBM Tools, Private Sector Negotiation (2021)

PCMA’s The Critical Path Forward Will Save Taxpayers $255.5 Billion Over 10 Years One Pager (2021)

This one pager highlights, The Critical Path Forward, PCMA’s three-part approach to lower prescription drug costs and make high-quality pharmaceutical care even more accessible. By updating Medicare Part D, enhancing competition to lower drug costs, and building a more value-driven health care system, our approach would save taxpayers $255.5 billion over a decade.

CO DOI Insulin Copay Regulation Amendments Comment Letter (2022)

PCMA submitted the attached comments on the DOI’s proposed amendments to Colorado’s insulin copay regulations.  The proposed amendments were meant to implement the changes from HB 21-1307

P&T Committees One Pager (2018)

One Pager outlining the importance and value of state P&T Committees.

Requiring Cost-Based, Cost-Plus Pharmacy Reimbursement Raises Costs and Undermines Value (2021)

One pager addressing implications of NADAC + Reimbursment mandates.

Dispensing Fees Infographic (2021)

Infographic addressing cost of NADAC + Dispensing Fees.

A 21st Century Pharmacy–Mail Service Pharmacies Infographic (2021)

Value of MAC Lists in Keeping Generics Affordable Infographic (2021)

PBMS Are Innovating to Increase Affordable Access to Insulin

Five Facts on Insulin (2021)

Milliman Research Report: Cost of Potential Frozen Formulary Legislation (2021)

A Research report conducted by Milliman assess the financial impact of potential “frozen formulary” legislation on fully insured commercial health insurance market payer costs from 2021-2025. The research finds that it would cost the commercial market between $4.3 billion to 7.1 billion.  Read the full report and analysis.

Frozen Formulary Talking Points (2021)

Talking points that explain and address ‘Frozen Formularies’

Explaining Prescription Drug Formularies (2021)

An explainer of prescription drug formularies and the array of PBM formulary management tools.

PBMs as a Fiduciary One Pager (2021)

A one pager explaining the negative impact with state proposals to impose a fiduciary mandate on PBMs

Illinois Fiduciary Mandate Fiscal Impact (2021)

Cost impact of proposed PBM fiduciary mandate provision in Illinois.

Washington Mandated Pharmacy Reimbursement Rate Fiscal Impact

Mandating a Prescription Drug Reimbursement Rate Could Cost Washington Over $3.2 Billion Dollars in Increased Spending

Utah Mandated Pharmacy Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Utah Over $1.7 Billion Dollars in Increased Spending

South Dakota Mandated Pharmacy Reimbursement Rate Fiscal Impact (2021)

New South Dakota Legislation mandating NADAC reimbursement plus dispensing fee Could Cost Over $419 Million Dollars in Increased Spending

Pennsylvania Mandated Pharmacy Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Pennsylvania Over $7.1 Billion Dollars in Increased Spending

North Dakota Mandated Pharmacy Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost North Dakota Over $382 Million Dollars in Increased Spending

Nevada Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Nevada Over $1.4 Billion Dollars in Increased Spending

Nebraska Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Nebraska Over $1.1 Billion Dollars in Increased Spending

Kentucky Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Kentucky Over $2.7 Billion Dollars in Increased Spending

Kansas Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Kansas Over $1.8 Billion Dollars in Increased Spending

Illinois Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Illinois Over $6.2 Billion Dollars in Increased Spending

Alaska Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Mandating a Prescription Drug Reimbursement Rate Could Cost Alaska Over $226 Million Dollars in Increased Spending

Alabama Mandated Prescription Drug Reimbursement Rate Fiscal Impact (2021)

Fiscal Note of AL legislation mandating a $10.50 dispensing fee would cost state over $3.4 Billion dollars in increased spending.

Supreme Court and ERISA One Pager (2021)

Rutledge V PCMA Talking Points (2020)

PCMA V Scotus Rule One Pager (2020)

Real Time Benefit Tools Talking Points (2022)

Audits Save Money and Protect Consumers One-Pager (2022)

PBM Facts (2022)

One pager addressing common PBM arguments and the PBM “facts” vs “misconceptions”

MS HB 733 & HB 780 Comment Letter (2022)

Opposition letter to HB 733, which seeks mandate NADAC reimbursement, limit ability for preferred networks, as well as provisions on pharmacy audits.

MN HF 3854 Comment Letter (2022)

PCMA concerns with HF 3854, a prohibition of step therapy for antiretroviral drugs

MN HF 3611 Testimony (2022)

Testimony before the House Commerce Committee addressing Copay Accumulators

MN HF 3280 Testimony (2022)

PCMA Testimony addressing HF 3280, a white bagging bill

MN HF 58 Testimony (2022)

Testimony on bill addressing frozen formulary