Credit: Greentech
Alaska has a new law that lets the Alaska Division of Insurance license and supervise pharmacy benefit managers — and the same new law lets the division license and regulate health plans' "third-party administrators."
TPAs help commercial health insurers, employers' self-insured health plans and government health plans administer health benefits.
The federal Employee Retirement Income Security Act tries to promote uniformity in benefits regulation by preempting state regulation of the kinds of large, multistate health plans that are subject to ERISA.
But federal law also leaves regulation of the business of insurance to the states.
Alaska has tried to avoid violating ERISA uniformity rules by providing an exemption for TPAs that provide administrative services only for ERISA plans.
But a employer health plan TPA that is subject to the new law, because it also serves commercial health insurers or government health plans and will have to designate a compliance officer, pay a $2,000 TPA application fee, according to a bulletin posted by the Alaska Division of Insurance.
When the division examines a TPA, the TPA will have to pay for the examination
The backdrop: Pharmaceutical manufacturers, pharmacies and some employers have accused PBMs of using complicated, opaque strategies that let them keep a big share of any prescription drug discounts they negotiate and give them an incentive to push up the full price of drugs, to increase the amounts of the discounts they can obtain and the value of any discount-related revenue.
The PBMs have argued that other players are trying to punish them for their successful efforts to hold down other players' profit margins.
But some researchers and others have suggested that the same criticisms made of PBMs could apply to TPAs.
Some state and federal PBM bills have included TPA provisions.
What it means: One question has been whether the bills with TPA provisions would move forward and whether any TPA provisions that became law could really have much effect on TPAs.
The arrival of the Alaska TPA law suggests that the TPA provisions can move forward and can have a noticeable effect on TPAs.
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