Posted: May 7, 2021
Arkansas was among the vanguard of states fighting to regulate Pharmacy Benefit Managers (PBMs) when news of their practices reached legislators. Their efforts to protect pharmacies from the predatory and anti-competitive actions of PBMs culminated in the Rutledge v. PCMA case that was heard in the United States Supreme Court. Arkansas emerged victorious in that case, which re-affirmed their right to regulate certain activities by PBMs at the state level.
Building on that momentum, Arkansas tackled two utilization management practices used by PBMs during their 2021 legislative session. SB 99, SB 446, and HB 1569, were all signed into law this session and should significantly improve patient access in the state beginning in 2022.
SB 99 and SB 446 both reformed the use of step therapy in the state. SB 99 reformed the practice by requiring that health plans and PBMs base their protocols on clinical guidelines and high-quality evidence, allows prescribers to override the protocols under certain circumstances, and ensures that prescribers receive a determination within 24 or 72 hours. SB 99 enacted these reforms for commercial and state employee plans in the state, and SB 446 extended those protections to the Arkansas Works Medicaid expansion population.
HB 1569 reformed the use of accumulator adjustment programs. These programs prevent the value of copay assistance from being applied towards a patient’s deductible as an out-of-pocket expense. Health plans and PBMs are effectively double dipping by collecting the value of the deductible twice. In doing so, patients are unlikely to be able to afford their medication. HB 1569 prohibits use of these programs except when a medically appropriate generic equivalent is available.
These reforms would not have been possible without the strong support of the rheumatology community and the rheumatologists in Arkansas who worked to support these pieces of legislation. CSRO applauds the Arkansas legislature’s dedication to enacting PBM related reforms, and looks forward to their next actions.
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