What Do The ACA and Other Federal Regulation of Pharmacy Benefits Managers Mean For Their Future Operations?

January 25, 2016

Cynthia J. Borrelli

Publication
Federation of Regulatory Counsel Journal

Cynthia J. Borrelli



Healthcare reform is evoking change in pharmacy benefit management. Pharmacy and medical care must become more integrated to create affordable drug programs to align with accountable care organizations (ACOs) and health insurance exchanges (HIExs) lines of business perpetuated by the Affordable Care Act (ACA) and increasing regulation of healthcare delivery. Managed care techniques such as narrow pharmacy networks, integrated care programs, medication therapy management, cost trend management of specialty pharmacy drugs, and pay-for-performance models resulting from implementation of the ACA will help mitigate the potential adverse impacts of healthcare reform on the pharmacy component of healthcare, as well as highlight pharmacy benefits as a prominent feature in post-ACA healthcare delivery.

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