Pharmacy Benefits Managers In Del. Subject To Tighter Regulations

The Pharmacy Benefits Manager industry in Delaware is huge – and, it will be more tightly regulated.

The PBM acts as the intermediary for prescription drug plans. Their decisions affect reimbursement rates for pharmacies, and ultimately the price paid by consumers for prescription medications.

Legislation passed in the Delaware General Assembly (House Bill 219) this year gives the Department of Insurance the ability to regulate pharmacy benefits managers and enforce consumer protection measures.

Referring to testimony delivered by a witness during legislative hearings, Insurance Commissioner Trinidad Navarro said “”with more consumers and local pharmacies facing dire financial situations, and more PBM wrongdoing coming to light, we must act with urgency in reining in this industry. In a developed nation, it is unconscionable that a mother would have to go hundreds of miles to get her child’s medication affordably, and no pharmacy should have to fight for months on end for the right to provide their clients needed pharmaceuticals without going bankrupt.”

“For too long, pharmacy benefit managers’ egregious predatory practices have put profits above consumers. With this legislation, we are implementing critical reforms that will improve the oversight of this murky industry and ensure everyday Delawareans are not taken advantage of in such a vulnerable way,” Representative Andria Bennett, D-Dover said. Bennett chairs the Pharmacy Reimbursement Task Force. “I’m grateful for the outpouring of support this legislation has received both in the General Assembly and from individuals and small businesses throughout our state. We owe it to residents to fight for their best interests by increasing affordability and access to needed medication. That’s exactly what we’re doing with HB 219.”

According to the bill, the legislation requires use of the National Average Drug Acquisition Cost for pharmacy reimbursement, prohibits unequal payments to unaffiliated pharmacies, and provides the Department of Insurance with the ability to investigate PBMs, enforce consumer protection measures and incentives corrections through increased regulatory authority.

HB 219 aims to solve many of these issues through efforts such as required use of the National Average Drug Acquisition Cost for pharmacy reimbursement, prohibiting unequal payments to unaffiliated pharmacies, and providing the Department of Insurance the ability to investigate PBMs, enforce consumer protection measures, and incentivize corrections through increased regulatory authority.