One of the most powerful and underappreciated players in the healthcare industry are pharmacy-benefit managers, or PBMs, who oversee drug-benefit plans for employers and health insurers. Their job is to hold down the cost of providing those benefits by negotiating with pharmaceutical manufacturers to help lower drug prices, although critics of the PBM industry and it current business models argue that PBMs may directly benefit more from drug price inflation than actually holding down drug prices, and some data indicates that PBMs and their insurer clients may prevent patients and their employers from capturing the full benefit of bargaining process and contribute to affordability problems in the medical marketplace. 

PBMs impact a range of stakeholders from payers, pharma, physicians, patients, and policymakers, and present complex legal issues ranging from Fraud & Abuse, ERISA, and Antitrust, to compliance with Federal Pricing Reporting requirements.

This course, presented by Rujul Desai, Vice President of Avalere Health and Stephanie Trunk, Partner at Arent Fox, is designed to introduce attendees to the unique dynamics of the PBM industry in order to better advise clients on the legal, regulatory, and policy risks in today’s evolving healthcare landscape.

1. Discuss the unique role of PBMs in helping manage overall healthcare spending trends and their evolving business models
2. Outline the core activities and financial relationships between PBMs and drug companies, payers, pharmacies, providers, and patients
3. Identify key areas of legal risk for various stakeholders associated with the unique dynamics of PBM expansion and consolidation
4. Review recent state and federal policy activity relating to PBM transparency, regulation, and accountability within the overall debate to address rising drug costs