Navigating Litigation Involving Pharmacy Benefit Managers

Pharmacy Benefit Managers, or PBMs, help manage prescription drug benefits for health plans. When a patient fills a prescription, the pharmacy sends a claim to the PBM, which decides how much to pay. Payments typically include the ingredient cost and a dispensing fee for the pharmacy’s work. These payments are determined through contracts among PBMs, pharmacies, drug manufacturers, and health plans, making the system complex.

PBMs are increasingly facing legal and regulatory scrutiny. They are involved in antitrust cases, with allegations that some practices may inflate drug prices or disadvantage pharmacies. State-level actions are challenging PBM ownership of pharmacies and their reimbursement practices, while other lawsuits regarding underpayments and excessive fees highlight concerns about transparency and fairness. Federal investigations by the FTC are also examining rebate structures and pricing practices, reflecting broader attention on PBMs’ role in healthcare costs.

The team and experts at Vega Economics have been retained in numerous matters addressing the range of issues that arise in PBM-related cases. Our experts include leading antitrust economists and industry professionals with hands-on experience in the healthcare and pharmaceutical sectors. Whether you are evaluating potential litigation or are further along in the process, we are happy to discuss how we can assist and connect you with the right experts. Email us at experts@vegaeconomics.com for more information!