For the past couple of years, America has witnessed a growing movement led by Ohio and a few other states to crack down on once-obscure pharmacy benefit managers, who are accused of huge overcharges in their role as middlemen in the prescription drug supply chain.
So far that effort has concentrated on perceived PBM abuses in public sector programs, especially Medicaid, a state-federal program funding health care for the poor and disabled.
But PBMs are virtually everywhere, part of almost every health-care plan, and affect far more than the cost of prescription drugs.
Now, private sector and nonprofit groups are coming to the realization that they also might be paying too much, just like their public sector counterparts.
Yet, the constant challenge was wearing on the 54-year-old Marley â enough that when the COVID-19 pandemic began to be felt locally during the spring, Marley began contemplating retirement and selling the business at 5008 Peters Creek Parkway in Winston-Salem.
A potential transaction fell through in July, with that company failing due to COVID-19-related funding issues, Marley said.Â
Conversations with Medicure progressed quickly, with Marley agreeing in September to sell the stock in Marley Drug to the Winnipeg, Manitoba-based company. The sale was completed Thursday.
Medicure said it has made an upfront payment of $6.3 million, with potential additional payments based on future performance of the pharmacy. Medicure intends to finance the acquisition with a term loan from a Canadian commercial bank.
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In a unanimous (8-0) opinion authored by Justice Sotomayor, the U.S. Supreme Court held that an Arkansas state law regulating rates at which pharmacy benefits managers (PBMs) reimburse pharmacies is not preempted by ERISA. (Justice Barrett took no part in the consideration or decision of the case.) While most people would not think of ERISA preemption issues as affecting their daily lives, the Court’s opinion could have greater implications than one might imagine given that at least forty states currently regulate some aspect of PBM activities, and the significant impact PBMs have on the cost of pharmaceuticals.
Arkansas Attorney General Leslie Rutledge added an impressive win to the list of her achievements when the Supreme Court ruled in her favor on Thursday, against the Pharmaceutical Care Management Association.
Craig Wilson, with the Arkansas Center for Health Improvements wrote in October: âThe Pharmaceutical Care Management Association, which is the national trade association for PBMs, maintains that federal law, the Employee Retirement Income Security Act of 1974, or ERISA, preempts the 2015 Arkansas law, prohibiting the state from directly regulating how plans pay for benefits.â
Justice Sonia Sotomayor delivered the opinion of the Court, in which all other members joined except Justice Amy Coney Barrett, who took no part in the consideration or decision of the case.
Tuesday, December 15, 2020
In
Rutledge v. Pharmaceutical Care Mgt. Assoc., U.S. –, 2020 WL 7250098 (Dec. 10, 2020), the Supreme Court held that ERISA’s broad express preemption will not reach a state law that focuses on the price of prescription drug benefits that a plan chooses to provide.
The particular question in
Rutledge was whether ERISA preempted an Arkansas law regulating the price at which pharmacy benefit managers (PBMs) reimburse pharmacies for the cost of drugs covered by ERISA prescription drug plans. The Court described PBMs as
a little-known but important part of the process by which many Americans get their prescription drugs. Generally speaking, PBMs serve as intermediaries between prescription-drug plans and the pharmacies that beneficiaries use. When a beneficiary of a prescription-drug plan goes to a pharmacy to fill a prescription, the pharmacy checks with a PBM to determine that person’s coverage and copayment information. After the b