PBM Model Bills, State PBM Laws and PBM Resources
Pharmacy Benefit Managers, often known simply as “PBMs,” are largely unrecognized by most employees—and even by many benefits managers. But they have a tremendous impact on U.S. health care decision-making because they influence more than 80 percent of drug coverage. The information below is intended to provide a record of NCPA’s efforts regarding PBMs as well as any bills that have been introduced or any laws that have been passed on a state level regarding their practices.
FTC Letters NCPA has worked with many members of Congress to communicate with the Federal Trade Commission about the CVS Caremark Merger
- Letter to FTC from Congressman Jordan PDF (599k)
- Current List of Congressional Letters to FTC PDF (27k)
- Letter to FTC from Senators Dorgan, Feingold, and Klobuchar PDF (131k)
- FTC Letter to Representative Chu PDF (38k)
- Congressman Gerlach Letter to FTC PDF (98k)
- Congressman Jordan's Letter to FTC PDF (596k)
- Congressman Kissel's Letter to FTC PDF (246k)
- Congressman's Latta's Letter to FTC PDF (136k)
- Letter to FTC from Senators Brown and Lautenberg PDF (405k)
- Letter to FTC from Multiple Members of Congress PDF (433k)
- Letter to FTC from Senators Pryor and Wicker PDF (374k)
- Letter to FTC from Representative Sanchez PDF (280k)
- Letter to FTC from Representative Schakowsky PDF (149k)
PBM Blog Posts Posts regarding PBMs that can be found on NCPA's Official Blog the Dose.
- CVS Caremark Practices Draw Unprecedented Media Scrutiny
- CVS Caremark, FTC Investigation Still Hot Topics in Washington
- About those Mail Order Savings
- Commoditizing Pharmacy, Commoditizing Adherence
- Lies, damned lies, and PBMs
- Examining PBM Arguments Against Greater Transparency in the Federal Employee Health Plan
- When No Drug Coverage Beats CVS Caremark Coverage
- PBM Transparency and the CVS Caremark Conundrum
- Bending the Cost Curve through Pharmacy
- PBM Profits Soar Even as Drug Costs Rise
- CBO Contradicts PBMs on Transparency
This section is intended to provide background information regarding PBMs.
PBM Resources
- Sample Maintenance Choice Letter Doc (18k)
- Sample Letter to Attorney General Doc (16k)
- Drug Benefit Brochure PDF (243k)
- CVS Caremark Ad PDF (1M)
- HR 5234 Hand Out PDF (23k)
- Letter from Representatives Welch and Braley to Representatives Waxman, Stupak, and Pallone PDF (362k)
- Handout for HR 5234 and HR 5235 PDF (48k)
- False Savings of Mail Order Pharmacies PDF (108k)
- NCPA Mail Order Presentation PPT (520k)
- NCPA Applauds Rep. Weiner for Introducing Bill to Rein in Pharmacy Benefit Manager Practices That Hurt Patients, Plan Sponsors and Community Pharmacies
- Facts and Myths About PBM Transparency PDF (29k)
- PBM Talking Points PDF (21k)
- PBMs: Where’s the Money Going? August 09 PDF (50k)
- PBM Transparency Does Not Increase Drug Costs PDF (72k)
- The Demonstrated Savings from PBM Transparency Appendix A PDF (47k)
- NCPA Letter to FTC Regarding CVS/Caremark Merger PDF (93k)
- Audit Report on PBM Contracts at State Agencies and Educational Institutions PDF (2.5M)
- Overview of the State Auditor's Office of Texas—Report on PBM Contracts PDF (22k)
- Is the Pharmacy Benefit Manager Truly Transparent? Trust but Verify PDF (798k)
- 10 Questions Company Benefits Managers Must Ask Their PBM PDF (1M)
- PBM Fact Sheet PDF (63k)
- Ongoing Federal and State Litigation Regarding Pharmacy Benefit Managers PDF (81k)
- State of Texas: Moving Towards PBM Transparency PPT (565k)
- Final Judgement: State of Illinois vs Caremark PDF (2M)
PBM State Model Legislation and Resource Information NCPA Model Legislation:
NCPA has prepared model legislation as a regulatory framework for states to consider when addressing PBM business practices. The model language provides standards and criteria for the regulation, solvency and licensing of PBMs. Those standards include transparency, substitution criteria, fiduciary requirements and contract provisions.
- The Pharmacy Audit Integrity Act PDF (25k)
- State PBM Model PDF (21k)
The information below includes copies of certain state PBM laws and an overview of state laws that regulate the business practices of PBMs.
State PBM Laws
- State of Maine Title 22, §2699, Prescription Drug Practices PDF (35k)
- State of North Dakota Chapter 26.1-27.1 PDF (16k)
- Laws that Provide Regulation of the Business Practices of Pharmacy Benefit Managers PDF (45k)








