NCOIL Approves Model State PBM Regulation

NCOIL Approves Model State PBM Regulation

On Saturday, Dec. 10, the National Conference of Insurance Legislators (NCOIL) approved model legislation for states looking to address unfair PBM practices.

The model act, known as the Pharmacy Benefits Manager Licensure and Regulation Model Act, aims to address PBM regulation on the state level in a variety of ways.

Kansas Rep. Willie Dove was one of the legislators present at the meeting.

Here are some of the highlights of the act, according to NCPA:

  • Gives the state oversight authority over the under-regulated PBM industry
  • Requires PBMs to obtain a license from the state insurance commissioner and allows the commissioner to review and audit PBMs to ensure compliance with the model act’s provisions
  • Provides the commissioner with the authority to adopt rules that promote, preserve, and protect public health, safety, and welfare through effective regulation of PBMs
  • Prohibits gag clauses in contracts
  • Sets out rules that an insurance commissioner may adopt, including network adequacy requirements, compensation/MAC lists, MLR abuses, and prohibited market conduct practices
  • Does NOT provide an ERISA exemption – a victory for the patients, pharmacies, and states because it gives the states the flexibility to enact legislation they deem necessary for their state without hitting the “self-funded” roadblock

Along with NCPA, Currus is encouraged by this recent news and we plan to educate new Kansas Insurance Commissioner and pharmacist Vicki Schmidt on this in the coming months.