The National Association of Insurance Commissioners (NAIC) may try to set national standards for regulating pharmacy benefit managers (PBMs.)
An arm of the NAIC has agreed to move toward developing a PBM model regulation.
Members of the NAIC’s Regulatory Framework Task Force voted Saturday to approve a PBM model law development effort, according to the NAIC.
Officials note on the PBM model development proposal form that the effort could be difficult, because so many states have already developed their own PBM regulation programs.
“The issue will be whether these states will want to re-open those laws or regulations after adoption the new model,” officials say.
The PBM Issue
PBMs help health insurers and employer-sponsored health plans bargain with drug manufacturers.
Some PBM revenue is tied to the size of the discounts PBMs negotiate. PBM critics say that, in some cases, PBMs are maximizing their discount-linked revenue by pushing up the full list prices of drugs.
In other cases, critics say, PBMs are maximizing their revenue by taking too big of a cut of the discounts, and increasing the amounts insured consumers actually pay for important drugs, such as insulin, out of their own pockets.
Where the NAIC Fits In
The NAIC is a Kansas City, Missouri-based group for state insurance regulators.
States often use NAIC models when developing their insurance laws, regulations and procedures.