Delaware Department of Insurance targets drug benefit managers


The Delaware Department of Insurance will lead a state effort to regulate the pharmaceutical benefit manager industry.

The insurance department will be drafting regulations shortly, looking for areas to save money and fill in the gaps as a new law comes into force.

HB 219, adopted by the General Assembly earlier this year, aims to reduce drug costs while preserving local pharmacies.

The state is trying to curb the Pharmacy Benefit Managers (PBM). They act as intermediaries for drug plans, influencing the drugs covered and the costs of those drugs to consumers and pharmacies.

Insurance Commissioner Trinidad Navarro explains what tools the state has to control PBMs.

“In the future, we may take corrective and enforcement action such as imposing a fine or even revoking a PBM authority to operate in the state if repetitive, I suppose blatant, actions continue to occur. happen, ”Navarro said. “We are already registering PBMs and we have almost 30 registered to date.”

Navarro says that under the new law his office will also have other tools to achieve these goals.

“The insurance department now has the capacity to investigate PBMs, can enforce consumer protection measures and push for corrections through the regulator,” Navarro said.

The new law also aims to solve many problems of access and unequal treatment through the use of the national average cost of acquiring drugs for reimbursement of pharmacies, prohibiting unequal payments to unaffiliated pharmacies.

To better understand existing PBM processes, the department recently launched introductory market conduct reviews on registered PBMs. The initial reviews will not result in fines or enforcement action, but they will highlight areas for improvement, including those that do not comply with the new law and will require corrective action plans.

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