Enforcing PBM Reform: Breaking the PBM Cycle of Disregard
Passing legislation to regulate Pharmacy Benefit Managers (PBMs) is a monumental achievement, but it’s only half the battle. The real challenge—and the key to meaningful change—lies in strict, consistent enforcement. In this critical episode of PUTTcast, co-hosts Lauren Young and Monique Whitney sit down with a powerhouse panel of legal and pharmacy industry experts to dissect the current state of PBM law enforcement.
Joined by special guests Mark Boesen of Boesen & Snow Law, Matt Seiler of NCPA, and Miguel Rodriguez of American Pharmacies, this episode takes a deep dive into the massive gap between existing PBM reform laws and on-the-ground compliance. Our panel breaks down the recent Federal Trade Commission (FTC) proposed settlement with Express Scripts, exposing what it means for independent pharmacies, and explores the recent alarming state audit findings that highlight a systemic failure by PBMs to follow state laws.
Whether you’re a pharmacy owner, a legislator, or a healthcare advocate, this episode will shed light on why robust enforcement at both the state and federal levels is not just beneficial, but absolutely vital for the survival and longevity of the independent pharmacy industry.
Music by cat_herding_diva [https://pixabay.com/users/soulprodmusic-30064790/] | Production & Editing by Shannon Wightman-Girard
KEY TAKEAWAYS
1. The Enforcement Gap: Having laws on the books means little without the resources and regulatory teeth to hold PBMs accountable for non-compliance.
2. Government Role in PBM Oversight: The Express Scripts proposed settlement signals a shift in federal attention, with the goal of creating new precedents for how PBM practices are handled.
3. State Audits Reveal Systemic Issues: Recent state-level audits have uncovered glaring patterns of PBMs ignoring statutory mandates, emphasizing the need for stricter state DOI and AG interventions.
4. Future Enforcement Guidelines: Future PBM reforms must include built-in enforcement mechanisms, mandatory auditing, and severe penalties for violations.
5. Benefits to the Industry: Proper enforcement ensures fair reimbursement rates, protects patient choice, and levels the playing field for independent pharmacies.
GUEST INFORMATION
Mark Boesen, PharmD, JD
Founding Partner, Boesen & Snow Law
Mark brings a unique dual perspective as both a pharmacist and a legal expert. He specializes in pharmacy law, regulatory compliance, and government affairs, fighting tirelessly for the rights of independent pharmacies.
Matt Seiler, Esq.
VP & General Counsel, National Community Pharmacists Association (NCPA)
Matt leads the legal strategy for NCPA, advocating for the nation's independent community pharmacies. He is at the forefront of the battle against anti-competitive PBM practices at the federal level.
Miguel Rodriguez, Esq.
EVP & General Counsel, American Pharmacies
Miguel is a leading voice in PBM litigation and legislative reform. Through American Pharmacies, he drives aggressive legal and advocacy strategies to ensure PBM transparency and accountability.
JOIN THE FIGHT FOR PBM REFORM!
If you found this episode valuable, please share it with your colleagues, state representatives, and fellow pharmacy advocates. Make sure to subscribe to PUTTcast on your favorite podcast platform so you never miss an update on the fight for fair pharmacy practices. For more resources and to join our mission, visit our website at TruthRx.org [https://truthrx.org]
