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NCPA June 27, 2022

NCPA presents to NAIC PBM subgroup
NCPA’s Matt Magner, director of state government affairs, presented to the National Association of Insurance Commissioners’ PBM regulatory issues subgroup on obstacles to robust enforcement of state PBM laws. He explained that, despite the enactment of PBM reform laws, confusion over federal preemption (i.e., the topic of the U.S. Supreme Court Rutledge decision) and legislative loopholes leave many patients exposed to PBM abuses. NCPA was invited to present to the subgroup as part of NAIC’s efforts to draft a white paper on PBMs’ role in the drug supply chain and state efforts to regulate them.

Protecting access to community pharmacy in Florida’s Medicaid program
NCPA submitted a response to the Florida Agency for Health Care Administration’s request for information on ways to improve the Medicaid managed care program. NCPA’s comments focused on innovative ways to protect patient access to community pharmacist services, which was a topic highlighted by the RFI. NCPA pointed out that Florida can protect that access by doing one or more of the following: addressing patient steering, requiring MCOs/PBMs to adopt transparent reimbursement methodologies, administering pharmacy benefits through the fee-for-service program, or implementing a “single PBM” model.

NCPA responds to New York on PBM transparency
NCPA submitted a response to the New York Department of Financial Services’ request for information regarding PBM transparency. NCPA highlighted the importance of rules requiring PBMs to disclose certain benefit information to their plan sponsor clients. Information on PBM conflicts of interest, pharmacy reimbursements, price concessions, and other topics allow plan sponsors to prevent PBM abuses.

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