Mar 18, 2025 · Despite bipartisan support, a last-ditch effort to pass a healthcare package that included pharmacy benefit manager reforms was scuttled last week. This marks the umpteenth time that...

Jan 26, 2023 · This bill generally prohibits pharmacy benefit managers (PBMs) from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy.

Mar 12, 2025 · We explain the transition from traditional pharmacy billing handled by Pharmacy Benefit Managers (PBMs) to the adoption of medical claims submission using Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes.

Jul 7, 2023 · Pharmacy benefit managers are middlemen who work with drug companies and insurers, helping set the retail prices for prescription drugs Americans rely on for their health. They're now the...

Dec 14, 2023 · The House on Monday passed wide-ranging legislation (HR 5378) to require more transparency around pharmacy benefit manager (PBM) business practices, codify and expand Trump-era rules requiring hospitals and insurers to post prices online, and implement site-neutral payment policies in Medicare.

Mar 6, 2025 · Senate Democrats on Thursday are introducing as standalone legislation a package of health policies, including changes to the pharmacy benefit manager (PBM) industry that was left out of...

Mar 12, 2025 · A Republican and a Democrat are bringing back a pharmacy benefit manager reporting bill that nearly became law during the 118th Congress.

Jul 24, 2023 · This PBM data visualization highlights common provisions in state PBM legislation by frequency of enacted provisions. Key provisions include those extending protections to consumers, pharmacies, and state and commercial payers that contract with PBMs.

3 days ago · LITTLE ROCK, Ark. – Governor Sarah Huckabee Sanders today signed HB1150, legislation banning Pharmacy Benefit Managers (PBMs) from engaging in anti-competitive practices by simultaneously owning pharmacies. “For far too long, drug middlemen called PBMs have taken advantage of lax regulations to abuse customers, inflate drug prices, and cut off access to critical medications.

Apr 11, 2025 · State-level PBM reform efforts have gained traction, with 24 states passing 33 bills in 2024 to regulate PBM practices. Pharmacists are encouraged to advocate for PBM reform by engaging with state pharmacy associations and participating in legislative processes.