PBM Policy and Legislative Update — Summer 2024
Mintz’s PBM practice is pleased to present a 2024 year-to-date PBM Policy and Legislative Update. This edition builds upon prior issues and summarizes activity from January through June that impacts the PBM industry. It specifically highlights federal legislative activity and oversight, state legislation and litigation, and other noteworthy events and trends affecting the PBM industry.
In light of the volume of state activity in this space, we are changing how we report on proposed state legislation! As you will see, we included a topic/summary chart rather than individual descriptions for pending state legislation. We still provide a short description of the enacted state laws.
We hope you find the PBM Policy and Legislative Update to be a useful resource. If you have any questions, please do not hesitate to reach out to us!
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Authors
Theresa C. Carnegie
Member
Theresa advises clients on all aspects of the pharmaceutical supply chain, including counseling industry stakeholders on a range of business, legal, transactional, and compliance matters. She provides clients with strategic counseling and creative business modeling that considers legal restrictions and regulatory risk in light of innovation and business goals.
Tara E. Dwyer
Member
Tara advises managed care organizations, pharmaceutical services providers such as PBMs, and integrated delivery systems, and companies that invest in them, on matters relating to compliance with federal health care program regulations, federal and state fraud, waste and abuse laws and plan benefits.
Rachel A. Alexander
Member
Rachel A. Alexander, a Member at Mintz, is a seasoned health law attorney and litigator who represents health plans, payors, and managed care entities in all aspects of managed care and payor regulatory, transactional, and litigation matters. She has a specialized focus on pharmacy benefit and drug pricing–related issues. She is regularly called on to help clients navigate pharmacy benefit manager (PBM) contract negotiation, administration, and procurement matters and provide guidance on compliance with federal law.
Bridgette A. Keller
Of Counsel
Bridgette advises health care providers, ACOs, health plans, PBMs, and laboratories on regulatory, fraud and abuse, and business planning matters, applying her experience in health system administration and ethics in health care to her health law practice.
Madison M. Castle
Associate
Madison M. Castle is an Associate at Mintz who focuses her practice on health care regulatory, transactional, and enforcement defense matters. She represents clients across the health care sector, including hospitals, physician organizations, and health care systems.
David R. Gilboa
Associate
David R. Gilboa is an Associate at Mintz whose practice encompasses transactional, compliance, privacy, and regulatory matters. He represents a broad spectrum of health care clients, including health care systems, hospitals, digital health companies, clinical laboratories, nursing homes, home care agencies, physician practices, and pharmacies.
Xavier G. Hardy
Associate
Xavier represents clients in the health care and life sciences fields on health care regulatory and fraud and abuse matters. He also handles Medicare and Medicaid reimbursement issues in transactions and business arrangements.
Samantha Hawkins
Associate
Samantha Hawkins is an Associate at Mintz whose practice encompasses a broad range of complex transactions, compliance and regulatory issues, and governance matters for clients across the health care sector, with an emphasis on pharmacy benefit manager (PBM) contract negotiation.
Stephnie A. John
Associate
Stephnie advises clients across the health care industry on regulatory, transactional, and compliance matters.
Pat Ouellette
Alison H. Peters
Associate
Alison H. Peters is an Associate at Mintz with a broad health law practice that encompasses counseling clients on regulatory, compliance, transactional, and legislative matters. She works with health care and life sciences clients, including pharmaceutical and medical device manufacturers, physician practice groups, hospital systems, clinical laboratories, pharmacy benefit managers (PBMs), private equity firms, trade groups, and executives of health care entities.
Abdie Santiago
Associate
Abdie Santiago is an Associate at Mintz who represents life sciences and health care companies in a broad spectrum of regulatory, fraud and abuse, and transactional matters. He assists clients with government drug pricing mandates, Medicare and Medicaid coverage requirements, Anti-Kickback Statute and False Claims Act investigations, and due diligence for health care practice transactions.
Hassan Shaikh
Associate
Hassan advises a broad range of clients across the health care industry—including health care systems, pharmacies, and private equity firms investing in health care companies—in complex industry transactions and compliance and regulatory matters.
Sophia Temis
Associate
Sophia Temis is an Associate at Mintz who focuses her practice on health care transactions and advising health care organizations on a broad spectrum of regulatory and governance matters. She represents physicians, hospitals, ambulatory surgery centers, and other for-profit and nonprofit health care clients.