Pharmacy Benefit Managers (PBMs), the middlemen that negotiate rebates and manage drug benefits for health plans, businesses and government programs, bill themselves as saving money for government and the private sector, but their record is a checkered one. NLARx is working with state legislators to enact laws establishing transparency, anti-kickback, conflict of interest and other ethical standards for PBMs, which have been targeted in numerous fraud cases and other litigation. The First Circuit Court of Appeals upheld the Maine law, the first such state law to be enacted, in a broad decision, finding it does not impermissibly step on the jurisdiction of the federal government, whether under the ERISA law or constitutional provisions regarding interstate commerce, protection of property (trade secrets) or free speech, and the Supreme Court has refused to review this holding.

Researching this Issue

Model state PBM laws and best practices, testimony supporting these initiatives, and background information and research materials including reports, legal briefs and decision, and news articles are posted here. Information on PBM fraud litigation is posted on the Medicare & Medicaid issue page. The Pharma Watch page is also a good resource for information on how the PBM industry markets itself. See also the Related Links below to connect to other organizations and materials with relevant information on this issue.

Model Legislation
Mar 16, 2012
PDF Link for Assembly Resolution No. 64 State of New Jersey | >>more
Nov 20, 2008
Phamacy Benefit Manager (PBM) Transparency and Fiduciary Standards | >>more
Jan 28, 2008
Model Conflict of Interest Disclosure Form and Agreement | >>more
>> view all Model Legislation
Dec 06, 2011
NLARx Opposes Merger of PBM Giants | >>more
Dec 07, 2010
Testimony Before the Employee Benefits Security Administration, U.S. Department of Labor | >>more
Feb 23, 2010
Statement of Sharon Anglin Treat Maine State Representative Executive Director National Legislative Association on Prescription Drug Prices | >>more
>> view all Testimony
Legal Briefs and Opinions
Apr 18, 2012
NLARx & consumer groups file "friend of the court" brief in PBM merger challenge | >>more
Jun 20, 2011
NLARx joins Friend-of-Court Brief in Texas Lawsuit Involving PBM CVS/Caremark | >>more
Jul 12, 2010
Decision PCMA v. District of Columbia, DC Court of Appeals | >>more
>> view all Legal Briefs & Opinions
Related News
Jan 17, 2013
CVS Fails To Have Whistleblower Lawsuit Tossed | >>more
Oct 24, 2012
Los Angeles Times
CVS Caremark has become a frequent subject of government probes | >>more
Sep 14, 2012
The Wall Street Journal
Prescription-Drug Wars Begin | >>more
>> view all News
Oct 09, 2009
NLARx, the Consumer Federation of America, and US PIRG Letter to Sen. Reid Supporting PBM Transparency | >>more
Mar 10, 2009
Tufts Study: 75% of U.S. Health Plans Reimburse for Off-Label Uses of Prescription Drugs | >>more
Feb 18, 2009
Rx Action in the States, 2009 | >>more
>> view all Reports
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