EP 150: PBM Regulation and Litigation and a Review of the J&J Case

NFP's Insights from the Experts

In this episode, Suzanne Spradley and Chase Cannon review the current state and federal regulation of pharmacy benefit managers (PBMs), focusing on litigation surrounding recent state-enacted PBM rules. Suzanne starts off with a high-level description of PBMs and the role they play in the group health plan context. Suzanne and Chase discuss the plethora of state laws (proposed and enacted) focused on PBM regulation and the role courts have played in ERISA preemption of state laws, including in Arkansas, Oklahoma, and North Dakota. Suzanne concludes with a discussion of ERISA fiduciary obligations in the context of the J&J lawsuit, including a few employer takeaways on establishing a process for making plan-related decisions on pharmacy and other benefits and administration.