For example, according to a recent report commissioned by FloridaвЂ™s Agency for Healthcare Administration, PBMs cost FloridaвЂ™s Medicaid program approximately $113 million dollars because of PBMsвЂ™ administrative practices, some of which include marking up drug prices before reimbursing the pharmacy. Critics claim that this has resulted in higher drug costs to the consumer, and small reimbursements to independent pharmacies, which are being squeezed out of business by PBMs. In recent years, PBMs have come under scrutiny by consumers and independent pharmacies who claim that PBMs are not focused on the consumer but are driven by profit. Some PBMs also own or have affiliate pharmacies: CVS Caremark is a subsidiary of CVS Health, (which owns CVS Pharmacies) Express Scripts offers an online pharmacy and Optum RX also purchased The Diplomat Pharmacy for $300 million in 2019.

The three largest PBMs вЂ“ CVS Caremark, Express Scripts, and Optum RX вЂ“ account for approximately 62 percent of the market. According to an article published by the National Institute of Health, there are approximately 60 PBMs in the United States. They have influence over what type of medication your health plan covers, as well as the amount of money your pharmacy will be reimbursed. PBMs are multibillion-dollar organizations that serve as middlemen between your health insurance company, drug manufacturers, and pharmacies. PBMs and other large insurance companies often use this preemption argument as a legal strategy to avoid state laws that provide greater protection for consumers and healthcare providers. Had the law been preempted by ERISA, then it would not have applied, and the PBMs would not have had to abide by ArkansasвЂ™ cost regulation. More specifically, the court held that the Arkansas law was not preempted by ERISA (Employee Retirement Income Security Act), a federal law that governs employee sponsored benefit plans. Pharmaceutical Care Management Assn., the Supreme Court held that an Arkansas law, which required PBMs to reimburse pharmacies at a rate equal to or higher than the acquisition cost from the wholesaler drug distributor, to be valid and enforceable. The opinion by the high court will allow states to regulate how much money PBMs are required to reimburse pharmacies for prescription medication. Supreme Court recently ruled against Pharmacy Benefit Managers (PBMs), scoring a win for smaller, independent pharmacies.

Cryospace brickell pbm