News & Analysis as of

Regulatory Oversight Pharmacy Benefit Manager (PBM)

Husch Blackwell LLP

Massachusetts Legislature Passes Bill Expanding Healthcare Industry Oversight

Husch Blackwell LLP on

On December 30, 2024, the Massachusetts Legislature passed House No. 4653, “An Act Enhancing the Health Care Market Review Process.” This bill includes sweeping changes focused on increased regulatory oversight and healthcare...more

Smart & Biggar

Evolving pharmacy landscape signals more stringent regulatory scrutiny of “patient steering”

Smart & Biggar on

The pharmacy landscape has evolved considerably over the past year, shining a spotlight on pharmacy “patient steering”, the practice of directing patients to certain preferred pharmacies. Though Quebec has long required that...more

Mintz - Health Care Viewpoints

Indiana Joins States Focusing on Consolidation of Health Care

On March 13, 2024, Indiana joined the ranks of states exercising greater oversight and regulation of health care transactions.  Senate Enrolled Act No. 9 (S.B. 9), which takes effect on July 1, 2024, requires written notice...more

Mintz - Health Care Viewpoints

Pharmacy Benefit Managers are on the Federal Government’s Radar: Senate, House, and Agency Proposals Seek to Increase PBM...

In conjunction with the surge in state legislative efforts to regulate the pharmacy benefit manager (PBM) industry, Congress and federal agencies have ramped up PBM oversight efforts as part of the ongoing battle to lower...more

Bressler, Amery & Ross, P.C.

New York Seeks to Regulate Pharmacy Benefits Managers

On February 23, 2023, The New York Department of Financial Services’ (“Department”) Pharmacy Benefits Bureau (“PBB”) announced a final request for public engagement as the Department looks to develop regulatory standards...more

Mintz - Health Care Viewpoints

PBM Regulatory Roundup (Summer 2022): States Continue PBM Oversight Activities

2022 continues to see a surge in state-led PBM enforcement efforts. This roundup provides a brief summary of Louisiana’s complaint against United Healthcare and OptumRx related to its Medicaid program and recent state...more

McDermott Will & Emery

[Webinar] 340B… Or Not 340B: Oversight, Compliance and Enforcement - July 15th, 9:00 am - 10:00 am PT

McDermott Will & Emery on

The 340B Program has gained national attention over the last decade, in part due to the opportunities it provides to generate revenue for participating entities without risk of significant enforcement penalties for...more

Kramer Levin Naftalis & Frankel LLP

NAIC Considers PBM Regulation; Additional Requirements Possibly on Tap

Pharmacy benefit managers (PBMs) should consider the implications of a model law making its way through the National Association of Insurance Commissioners (NAIC) that would establish a licensure requirement and rules of...more

Polsinelli

Third Party Administrator Newsletter - December 2019

Polsinelli on

Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of Their TPA and PBM Business Partners The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement...more

Polsinelli

Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of their TPA and PBM Business Partners

Polsinelli on

The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement action against an insurer after determining that the insurer had violated various provisions of Vermont’s insurance laws,...more

Polsinelli

National Association of Insurance Commissioners Considering Adoption of Pharmacy Benefit Manager Model Law

Polsinelli on

The Chair of the National Association of Insurance Commissioners (“NAIC”) Regulatory Framework (B) Task Force recently announced that the Pharmacy Benefit Manager Regulatory Issues (B) Subgroup’s (“PBM Subgroup”) will...more

Mintz - Health Care Viewpoints

New York (Again) Seeks to Regulate Pharmacy Benefit Managers

On January 15, 2019, Governor Cuomo released the 2019-2020 Executive Budget, which proposes substantial legislative changes that would affect pharmacy benefit managers (PBMs). Among other things, the law would require PBMs to...more

Sheppard Mullin Richter & Hampton LLP

The New California Regulatory Scheme for Pharmacy Benefit Managers

California recently passed Assembly Bill 315 to create greater regulatory oversight of pharmacy benefit managers (“PBMs”). The bill requires PBMs to provide more transparency regarding their operations. PBMs will have to...more

Akerman LLP - Health Law Rx

House Commerce Committee Urges the FTC to Investigate Past PBM Mergers

The leadership of the House Energy & Commerce Committee has called upon the Federal Trade Commission to undertake a retrospective review of past mergers involving pharmacy benefit managers (PBMs). ...more

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