Blackley on the Impact of State PBM Regulations

Chris Blackley, co-founder and chief executive officer of Prescryptive Health, a drug benefits technology company, discusses the states that developing legislation that put requirements on PBMs. “One of the most positive things coming out of the state level activity and engagement is the awareness and education of the market,” commented Blackley. “It's only recently within the last few years that people even know what a PBM is.”

New York, he said, is being active in this area, where they are establishing policy that requires PBMs and payers to provide to patients in real-time information that about their prescriptions. This is important because it address access barriers related to pricing. “A lot of legislation in the past has focused on the patients and the provider. Giving patients information in this way will have a much bigger impact. New York is the first state doing this and when others see the impact of doing that, many will follow.”

In addition, states are moving gag clauses, which are written into pharmacy contracts with PBMs and prohibit pharmacists from telling a patient when paying by cash may be less expensive than using insurance. “Gag clauses are another way of putting the pharmacy in jeopardy when they are not being reimbursed at a fair price. Pharmacies are dependent upon major companies for as much as 25%, 30%, 40% of their revenue. If a small, independent pharmacy loses a contract, they go out of business.”

But he says, we have to be careful that policies that try to solves these programs to make sure they don’t become so burdensome so that people can’t afford to drive positive change.