On Tuesday, Prime Therapeutics lost its bid to overturn legislation in Washington state that allows pharmacies to appeal reimbursement decisions by PBMs. Prime Therapeutics had filed a lawsuit challenging orders issued by the Washington State Office of the Insurance Commissioner after the OIC concluded that Prime had failed to comply with its regulatory obligations to reimburse claims submitted by Cle Elem Pharmacy. The Washington Court of Appeals first held that Prime’s interpretation of the statute contravened the plain language of the statute and went on to uphold the constitutionality of the statute. Citing the significant economic challenges faced by many Washington pharmacies, which led to the enactment of the legislation, the court determined that not only does the statute not violate the state constitution, but it also “serves the legitimate public purpose of maintaining access to pharmacies in rural and underserved communities.”
NCPA is pleased with this decision. Time and time again states are demonstrating they have the right to regulate the abusive practices of PBMs, including under-reimbursement. Other states should take notice as to what Washington has done. With additional PBM legislation currently under consideration in the state, we hope/expect lawmakers to support such efforts to protect community pharmacies with greater rigor and urgency.
