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Simone Colgan Dunlap Provides Insight in “The Legal Landscape for Patient Support Services”

Pharmaceutical Commerce

Simone Colgan Dunlap spoke to Pharmaceutical Commerce and discussed the significance for pharmacy benefit managers (PBMs) of the Rutledge v. Pharmaceutical Care Management Associate (PCMA) decision using the federal Employee Retirement Income Security Act of 1974 (ERISA) to strike down unfavorable state laws for individuals that handle the prescription drug benefits for health insurers, larger employers and Medicare Part D drug plans, among others. Read the full article to learn more about pharmaceutical professionals' insights regarding the case and what the future of patient support services may entail.

Below is an excerpt:

“ERISA preemption has historically been an effective tool for striking down state laws that regulate PBM activity,” says Dunlap. “I predict that the Rutledge decision will encourage states and pharmacy lobbyists to try to enact laws similar to Arkansas’ Act 900 (the law at issue in Rutledge), and to pursue more expansive laws that push the boundaries of Rutledge. The ruling enhances a state’s ability to enact and enforce laws governing PBM activity.”

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“Additional regulation of PBMs will generally be positive for community pharmacies that stand to benefit from laws that require PBMs to do things like update MAC lists and allow pharmacies to rebill claims when the pharmacy cannot obtain a drug at a cost that is lower than or at least equal to the MAC price,” adds Dunlap.

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“After that, there was a return to focus on more ‘normal’ topics like [usual and customary] pricing reporting, licensing, compliantly engaging with pharmaceutical manufacturers and shared services arrangements,” she says.

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