PBMs have come in for a lot of criticism, and an industry labeled a “middleman” isn’t going to garner a lot of popular support. But federal regulation of the PBM industry hasn’t gone very far. Increasingly, though, state legislatures and agencies are imposing new rules on PBMs. State regulation got a major legal boost in late 2020 when the Supreme Court ruled in Rutledge v. Pharmaceutical Care Management Association that Arkansas could impose requirements on PBMs.

“The bills filed or passed this year concern the licensing or registration of PBMs, requirements for more transparency in the drug supply chain, and protections for independent pharmacies, which have long complained that PBM practices force them into exploitative arrangements,” the Pew Charitable Trusts reported last year.

The clear majority of the respondents to our State of the Industry survey are in favor of the trend in state regulation.

Nearly two-thirds (65%) indicated that they were in favor of increased state oversight and regulation of PBMs. Ninety-one of the 100 respondents answered that question.

We also asked about specific state regulations. The results to those questions were not included in our print issue because of space constraints. They showed agreement with the many of the rules and regulations that have been proposed. For example, 73% of strongly or somewhat agreed with disclosure requirements on PBM indirect and direct revenue sources, and 57% agreed with bans on mandatory mail order.