January 21, 2021


Welcome to the Pharmacy Benefit Brief. This brief is your monthly snapshot of news from America’s prescription drug supply chain including pharmacy benefit managers, independent pharmacies, and drug manufacturers.



Set the Record Straight on Supreme Court’s PBM Decision…

Despite the narrative pushed by the independent pharmacy lobby, the Court’s short opinion in Rutledge v. PCMA simply upholds an Arkansas law as a type of “rate regulation,” which traditionally states have always had the power to enforce. It’s important to note that the Court did not rule the law as a form of good public policy. State policymakers should consider the narrowness of the ruling and be aware that the Court acknowledged the ruling could raise healthcare costs.

The Court’s ruling allows pharmacies to refuse filling prescriptions for patients if they determine the reimbursement for their services is not enough – and will put at risk an important tool used to incentivize pharmacies to purchase affordable prescription drugs.

PCMA President JC Scott explained the ruling in a recent op-ed, take a look: The Supreme Court and Implications for Lowering Rx Costs.



Big Pharma Schemes Raise Drug Costs…

A new white paper by the Pharmacy Benefit Management Institute (PBMI) shows how some drug manufacturers use tactics, like copay coupons, which only result in higher drug costs for health plan sponsors and patients. Take a look at the report: Solving America’s High Drug Cost Problem: Prevent Drug Company Tactics that Increase Costs and Undermine Clinical Quality.

The white paper also explains how prescription drug formularies are used by PBMs to lower prescription drug costs for patients and health plan sponsor.



Did you Know?

State legislation that aims to restrict the use of PBM tools can limit options that health plan sponsors can use to manage their drug benefit costs.

An updated analysis reveals the impact of a number of these types of legislative proposals, take a look: Increased Costs Associated with Proposed State Legislation Impacting PBM Tools.



The Latest in Rx News
  1. Rich Adams, President and Chief Operating Officer for IPM, explains the potential of biosimilars to improve outcomes and lower costs in a new op-ed: Applying the Value of Biosimilars to the Health-Care Industry
  2. In 2019, drug makers raised prices on seven widely used medicines by substantial amounts without any new clinical evidence to justify the increases, leading patients and insurers in the U.S. to spend an added $1.2 billion that year. Read the new analysis by the Institute for Clinical and Economic Review: Unsupported Price Increase Report
  3. A new article in Health Payer Intelligence, Payers, Patients Save With Value-Based Chronic Disease Management, outlines how value-based care agreement with a type 2 diabetes drug firm lowered payer and patient chronic disease management costs by 20 percent.