Healthy Skepticism Library item: 1904

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Radinsky G.
The spotlight on PBMs: federal enforcement of the anti-kickback statute on the pharmaceutical benefit management industry.
J Health Law 2003 Spr; 36:(2):213-46

Abstract:

Pharmaceutical benefit management companies (PBMs) act as intermediaries between pharmaceutical manufacturers and third-party payors to administer prescription drug benefits. While PBMs have increased in importance in recent years, they have simultaneously become the target of critics, including United States Attorneys and the Federal Trade Commission. This Article gives a brief overview of the federal enforcement environment in which PBMs are conducting business and discusses how PBMs’ rebates are negotiated. It then discusses the applicability of the federal Anti-Kickback Statute, which is the likeliest enforcement tool for prosecutors to use against PBMs. The Article concludes by discussing the steps PBMs can take to minimize their liability and provides insight into how effective the federal government will be in building fraud cases against PBMs’ current business practices.

Keywords:
Drug Industry/legislation & jurisprudence* Drug Industry/organization & administration Fraud/legislation & jurisprudence* Group Purchasing Insurance, Pharmaceutical Services/legislation & jurisprudence* Law Enforcement Managed Care Programs Negotiating United States United States Federal Trade Commission