Health Law group member Ivy K. Miller authored the article, “How PBM Reform Suddenly Got Rolling,” published in the March/April 2026 issue of the Massachusetts Bar Association’s Health Law Section Review. In the article, Ivy points out that there has been a significant shift in how pharmacy benefit managers (PBMs) are regulated at both the state and federal levels. “PBMs wield substantial leverage to bargain with drug companies and influence drug prices. One service that PBMs provide is to negotiate rebates that the drug companies pay to health plans. While lower co-pays may, in the short term, be a benefit to patients, high rebates typically result in drug companies raising the list price of the drug over time, which means higher consumer costs.”

Ivy explains that bills at the federal level and in many states across the country, including Massachusetts, have laid out creative strategies for mitigating PBMs’ various revenue streams. In Massachusetts, the newly established application for licensure requires extensive documentation, including audited financial statements, disclosure of any “material ownership interest(s)” in any entity “whose business impacts the PBM,” and reporting of all claims, including the amounts of those claims, paid for Massachusetts residents in the prior year.

“Requiring Massachusetts state licensure and reporting and federal attempts to rein in PBM compensation represent significant government actions toward controlling harms alleged as a result of PBMs’ market control, particularly for an industry that has been the subject of much scrutiny but little action to date.”

Read the article.