State-level policy efforts to regulate pharmacy benefit managers (PBMs).

Pharmacy Benefit Managers (PBMs) originated in the 1960s to address a market need providing services to insurance companies in managing the newly introduced prescription drug benefits. Since then, PBMs have been expanding their roles in the prescription drug supply chain and have come under scrutiny. As of November 2021, all 50 states have enacted some form of regulation on PBMs. These state-level regulations focus on a variety of different policy levers, many of which align with advocacy efforts led by community pharmacists that focus on business transactions between pharmacies and PBMs without evidence supporting how these policies would enhance the patient experience, improve population health, lower costs, or improve the experience of health care providers. Many state policies could help increase transparency, prevent anticompetitive behavior between PBM-owned and independently-owned pharmacies, and increased accountability of PBMs to plan sponsors. However, there were no direct mechanisms to ensure that the potential benefits of these policies would ultimately be realized as savings for the health care system or consumers, improved health outcomes, or increased quality of care.