Articles and Blogs

On January 30, 2026, the U.S. Department of Labor (“DOL”) proposed a regulation under the Employee Retirement Income Security Act (“ERISA”) that would require pharmacy benefit managers (“PBMs”) to make detailed disclosures to fiduciaries of employer-sponsored self-insured group health plans. The proposed regulation implements President Trump’s Executive Order 14273, Lowering Drug Prices by Once... READ MORE

On February 3, 2026, after years of false starts, federal regulation of pharmacy benefit managers (“PBMs”) became reality when the Consolidated Appropriations Act, 2026 (the “Act”) was signed into law by President Trump. For the first time, the Act imposes federal requirements on PBMs related to compensation, transparency, reporting and other matters to be... READ MORE

In the latest example of enforcement action against pharmacy benefit managers (“PBMs”), Michigan Attorney General Dana Nessel recently filed an antitrust lawsuit in federal court against Express Scripts, Inc. and Prime Therapeutics LLC, alleging the two PBMs engaged in an unlawful agreement to suppress pharmacy reimbursement rates and harm competition (the “Complaint”). The Complaint,... READ MORE

On January 14, the Federal Trade Commission (“FTC”) published its Second Interim Staff Report (“Report”) on pharmacy benefit managers (“PBMs”), focusing on PBM pricing practices for specialty generic drugs. The Report described significant markups of cancer, HIV and other chronic condition specialty drugs and high reimbursement rates paid by Caremark Rx, Express Scripts and... READ MORE

On September 20, 2024, the Federal Trade Commission (“FTC”) filed an administrative complaint against Caremark Rx, Express Scripts and OptumRx, and their affiliated group purchasing organizations (“GPOs”), for engaging in anticompetitive and unfair rebate practices resulting in the artificial inflation of insulin prices. The FTC alleged that by creating a system in which drug... READ MORE

On June 7, 2022, the Federal Trade Commission (“FTC”) announced that it would launch an inquiry into the business practices of the nation’s six largest pharmacy benefit managers (“PBMs”). The inquiry will investigate the impact of vertically integrated PBMs on the access and affordability of prescription drugs. This news comes at a time when... READ MORE

On December 10, 2020, the Supreme Court of the United States (the “Supreme Court”) unanimously overturned an Eighth Circuit decision in the case of Rutledge v. Pharmaceutical Care Management Association. In the case, the Supreme Court held that an Arkansas law known as Act 900, which regulates the rates at which pharmacy benefit managers... READ MORE

In the closing days of the Trump administration, OIG finalized a controversial rule (the “Final Rule”) to amend the discount safe harbor (“Discount Safe Harbor”) to the federal Anti-Kickback Statute (“AKS”), effectively changing the treatment of prescription drug rebates under the AKS. Beginning January 1, 2022,[1] certain reductions in price or other remuneration from... READ MORE

On July 24, 2020, President Trump announced four Executive Orders (“Executive Orders”) characterized as focusing on lowering drug prices via various mechanisms. These Executive Orders, described in more detail below, include: (1) Executive Order on Access to Affordable Life-saving Medications; (2) Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen; (3)... READ MORE

On January 8, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released an Informational Bulletin titled “Best Practices for Avoiding 340B Duplicate Discounts in Medicaid” (“Bulletin”). The Bulletin outlines best practices that CMS encourages state Medicaid agencies to consider to avoid the situation where a manufacturer provides both a Medicaid drug rebate and... READ MORE