GAO looks into PBM regulation

NCPA April 17, 2024

The Government Accountability Office (GAO) issued a report that examined state PBM regulation in five states using interviews with state regulators, health plan associations, pharmacy associations, and select national organizations such as Pharmaceutical Care Management Association (PCMA). The report focused on fiduciary requirements, drug pricing and reimbursement, transparency and reporting, networks, and enforcement. Unsurprisingly, in nearly all areas of regulation discussed in the report, PCMA and state health plan associations pushed back against oversight. From the state regulator perspective, the report demonstrated how widely different each state experience is, based on state law, authority to promulgate rules, and resources dedicated to PBM oversight and enforcement. The five states featured in the report were Arkansas, California, Louisiana, Maine, and New York.