Welcome to MythBusters, pharmacy edition. Every time a bill to crack down on PBMs is mentioned, lobbyists issue dire warnings that premiums will rise – and politicians get scared and often back down. But here’s the truth: according to a new analysis by NCPA, the theory doesn’t hold up in states that have adopted laws protecting patients and local pharmacies. NCPA’s state policy team compared premiums for prescription drug programs in states that have regulated PBMs to the national average. They found slower premium growth – and in some cases premium reductions – after lawmakers enacted laws that PBM lobbyists warned would send premiums skyrocketing. In Hawaii, for example, lawmakers passed a law barring PBMs from requiring patients to use mail-order pharmacies. The premium there was smaller than the national average after the law took effect. They found similar results in California and West Virginia, which passed similar laws. In Georgia, premiums went down substantially after the state banned forced mail-order. “PBM regulation is a relatively new frontier. They’ve had very little oversight for a very long time,” said Anne Cassity, NCPA’s vice president for federal and state government affairs. “More and more states are seeing how they behave, and how patients, taxpayers and local small businesses are affected, and they’re taking action. Based on what we can see in states that have pioneered PBM regulation, there’s no real connection between regulation and higher premiums. It’s a false argument, and it shouldn’t deter lawmakers from protecting their states from predatory PBMs.”
NCPA
