Oliver Lackey opened a pharmacy in his hometown of Fairview, Oklahoma, so he could “provide the best patient care.” He set up shop a decade ago in the local grocery store with “zero prescriptions.” Before long, business took off — yet he was still struggling.“I was getting more patients and was filling more prescriptions,” Lackey told Stateline. “But as I grew in revenues, my reimbursement from the insurance companies and PBMs every year was getting worse.”PBMs are pharmacy benefit managers, the intermediaries in the drug supply chain that manage prescription drugs for health plans. PBMs determine which drugs are available under a person’s insurance plan, set copayments and decide how much pharmacies must pay to acquire drugs. Oklaho PBMs argue that they use their bargaining power to negotiate lower drug prices for consumers and pharmacists. But critics say PBMs, some of which are owned by the largest health care corporations in the nation, engage in anticompetitive practices that lead to higher prices and drive independent pharmacies like Lackey’s out of business.In recent years, all 50 states have enacted laws designed to lower prescription drug costs by curbing the power of PBMs, according to the National Academy for State Health Policy, a nonpartisan research group. But thanks to a 50-year-old federal law called the Employee Retirement Income Security Act, better known as ERISA, almost none of those measures applies to the 65% of Americans who work for large employers that cover their workers through so-called self-funded health care plans.That could change if the U.S. Supreme Court upholds a PBM law enacted by Lackey’s home state of Oklahoma.Five years ago, Oklahoma tried to rein in PBMs by approving a measure barring them from forcing pharmacies to pay certain fees or requiring patients to use PBM-owned or -affiliated pharmacies. The law also prohibited PBMs from giving more generous reimbursements to their own pharmacies or arbitrarily booting pharmacies from their preferred networks.It was “the most aggressive, broadest PBM enforcement legislation in the country,” Oklahoma Insurance Commissioner Glen Mulready, a Republican, told Stateline. “And it was immediately challenged.”The Pharmaceutical Care Management Association, a trade association representing PBMs, sued to invalidate the law. In August of last year, the 10th U.S. Circuit Court of Appeals ruled that ERISA, the federal law, prevented Oklahoma from applying much of its law to self-funded health care plans.Greg Lopes, the trade group’s vice president of public affairs, said the Oklahoma ...
