Bitter Pill for Pharmacy Giants

PCMA has fared better in state capitols, where it can use its considerable lobbying muscle, than it has in the court system. The group noted on Monday that 17 states have abandoned proposed PBM regulations so far this year. The group said the states dropped their plans after realizing they would lead to higher drug prices. But supporters of such laws blame intense lobbying, coupled with confusion over the secretive PBM industry, for at least some of those defeats.

In the meantime, both North Dakota and South Dakota have managed to pass weaker versions of Maine's PBM law already. South Dakota has reportedly saved more than $800,000 in state health insurance costs as a result.

Meanwhile, some organizations that operate in states without PBM laws have simply established strict guidelines of their own. Treat points to the University of Michigan as an example. There, she says, university officials shifted away from traditional PBM plans and saved the university $4.3 million as a result.

"We are starting to have a track record demonstrating the fiscal benefits of greater transparency," Treat says.

Treat's group will be using that record to fight for Maine-like laws that are currently pending in New Jersey, New York, Pennsylvania and Rhode Island. But its opponents will continue to heavily arm themselves as well. Indeed, on Tuesday, PCMA unveiled a new study showing that Pennsylvania's proposal would supposedly raise prescription drug costs in that state. The proposal could lessen the use of mail-order pharmacies, which can generate outsize profits for PBMs.

For now, at least, the big three PBMs -- Caremark, Medco and Express Scripts (ESRX Quote) -- continue to enjoy favorable industry fundamentals. But one of those companies faces serious issues of its own. Notably, Caremark has been caught up in a sweeping investigation of companies suspected of possibly backdating stock-option awards to their executives.