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U.S. Supreme Court seeks opinion on Oklahoma’s PBM law appeal

U.S. Supreme Court seeks opinion on Oklahoma’s PBM law appeal

The U.S. Supreme Court requested the opinion of the Office of the Solicitor General on Oklahoma’s appeal regarding a Tenth Circuit Court ruling. The ruling limited Oklahoma’s ability to regulate pharmacy benefit managers (PBMs) under the state’s Patient’s Right to Pharmacy Choice Act, as reported by BestWire.

The Patient’s Right to Pharmacy Choice Act aimed to establish minimum, uniform access to pharmacy providers.

In 2023, the Tenth Circuit ruled that the law was preempted by federal law, including Medicare Part D. Following this, Oklahoma Insurance Commissioner Glen Mulready, supported by the state’s attorney general, petitioned the Supreme Court to review the decision.

Key provisions of the law, such as access standards, discount prohibitions, the “any willing provider” clause, and probation prohibitions, were challenged.

A group of 32 state attorneys general also backed this appeal, arguing that the Tenth Circuit’s decision creates uncertainty for state regulators and could harm consumers by limiting their access to independent pharmacies

These provisions sought to strengthen the negotiating power of independent pharmacies and ensure patients could choose their preferred pharmacies, according to Oklahoma regulators.

The Pharmaceutical Care Management Association (PCMA), the respondent in the case, argued that the Tenth Circuit’s decision was correct.

They claimed the Employee Retirement Income Security Act (ERISA) preempted Oklahoma’s law and that Supreme Court intervention was unnecessary. PCMA’s vice president, Greg Lopes, stated the Oklahoma law restricted prescription-drug benefit designs, reducing affordability, flexibility, and choice for employees.

The case concerning Oklahoma’s Patient’s Right to Pharmacy Choice Act is drawing attention. The Supreme Court recently requested input from the Solicitor General to weigh in on whether this law, which regulates PBMs, should stand or be deemed preempted by federal law.

This is an important procedural step that signals the Court is seriously considering reviewing the case.

The Tenth Circuit Court of Appeals ruled that four key provisions of Oklahoma’s law were preempted by federal law. These provisions aimed to prevent PBMs from restricting access to certain pharmacies and from influencing patient choices by steering them toward affiliated pharmacies.

The provisions also sought to increase access to independent pharmacies and enhance their bargaining power.

by Steve Hallo, senior associate editor