Pharmacy benefit manager reform is a major trend in state managed care policy, said Adam Colborn, director of government relations at the Academy of Managed Care Pharmacy (AMCP).
At AMCP 2023, Adam Colborn, director of government relations at the Academy of Managed Care Pharmacy (AMCP), lists other managed care policy trends falling under pharmacy benefit manager (PBM) reform, and the lack of new, state-level, value-based care policies related to pharmacy.
What are some major trends in state managed care policy?
The major trend that we see with state managed care policy is pharmacy benefit manager reform. This has been a trend for a while with state legislators, and it's really a pretty broad category of bills. There are lots of different things that fall under that umbrella. Network adequacy requirements are part of it. We see things like copay caps, we see things like any willing provider requirements that are included in this umbrella. So there are lots of different things that could fall under PBM reform.
It tends to focus on things like transparency and utilization management. Most of the states are sort of looking at this through a lens of drug price affordability for patients. So I would say that's probably the biggest trend affecting managed care pharmacy at the state level.
Is there any activity surrounding value-based care policies?
So we're actually not seeing very much in the way of value-based care policy at the state level when it comes to pharmacy. We've seen a lot more in previous years, but in 2023, there was a significant drop off in the amount of bills on this subject that we saw introduced. I think a lot of that has to do with legislators are focusing on other subjects such as PBM reform. But I think another factor is that value-based care is something that's very difficult for policymakers to get their head around.
Pretty much everyone agrees that we should have a health care system that promotes value, but there's a lot of disagreement on what policies actually achieve value-based care. You know, what are the best techniques to really deliver value-based care efficiently? So we see some of these techniques that are used by managed care organizations such as fee recruitments for pharmacies that are not hitting their quality metrics are politically unpopular, and I think that's an obstacle to the uptake of value-based care at the state level. Until we can get alignment from state legislators and state regulators on how we're willing to pay for value-based care, I don't think it's going to be an area where we see a lot of enacted legislation.