Pharmacy Benefit Managers (PBMs) were designed to negotiate lower prices for prescription medications and pass those savings along to the payers (employers, patients, and health plans).  Doing this in an honest manner and respecting their fiduciary duty to these various players was not all that lucrative so the PBMs shrugged off their fiduciary duties and began taking undisclosed margins and kickbacks from both sides of the equation, negotiating mainly on their own behalf, making certain to complicate pricing arrangements as much as possible to keep all other parties in the dark.

This includes a state by state update of the ten states most likely to consider new DPC legislation in the 2017 legislative session, along with two states contemplating revisions to their DPC laws.  Two upcoming events and some future projects are also mentioned.

Federal Changes:  1) The potential $100 per day fine for small employers offering DPC has been eliminated, 2) the DPC Coalition expects an HSA clarification within the two months of 2017 either with the passage of legislation or in the form of a presidential executive order (feel free to join the DPC Coalition for a DC fly in from Jan 4-6, and 3) there is speculation that states will be provided with more autonomy from the federal government to redesign their Medicaid programs (and many of these could involve DPC pilots).