House Bill 246 would control pharmacy benefit managers in North Carolina. It has been stuck in a Senate committee for more than a year, but other states have done the same thing and said it saved them millions of dollars.
One of the people who pushed for HB 246, Rep. Wayne Sasser, R-Montgomery, doesn’t agree with the PBMs’ claim that regulating them would make medicines more expensive.
He said, “The history of other states goes against that philosophy.” That’s right; in some places, “the cost of health care for the patient has gone down, not up.”
Act 900, which was passed in 2015 in Arkansas, lets a pharmacy dispute PBM payments that are less than what it cost the pharmacy to buy the drug. The act was upheld by the U.S. Supreme Court in 2020 with an 8-0 vote. This made it possible for states to control PBMs.
In 2024, Kentucky passed SB188, which made sure that PBMs include pharmacies close to customers in their networks as long as the pharmacies follow reasonable rules.
Spread pricing, in which PBMs charge health plans more than they pay pharmacists, was done away with, and the Washington State Healthcare Authority thought it saved the state $156.8 million in 2021.
Kentucky and West Virginia switched to using the same PBM. This saved Kentucky’s Medicaid program $282 million in 2021 and 2022 and about $54.4 million for West Virginia’s Medicaid program in 2018.
Josh Stein, the attorney general of North Carolina, sent a letter to Congress on February 20, 2024, along with 39 other attorneys general, asking them to control PBMs.