At the 2025 AMCP Annual Conference, a panel of experts discussed the growing impact of artificial intelligence (AI) in managed care pharmacy and offered recommendations for navigating its complex legal landscape.

Session moderator Adam Colborn, JD, associate vice president, congressional affairs at AMCP, and Editorial Advisory Board Member for First Report Managed Care, kicked off the presentation and highlighted examples of potential applications of AI in managed care pharmacy. These include using AI in management processes (eg, reviews and appeals) and patient portals to provide customer service or summarize documents.

Although there is significant potential for AI use, there are hazards to consider as well, according to Colburn. For example, patients might be dissatisfied with virtual assistants. In addition, AI systems can produce “inappropriate” outcomes, even when the correct data and parameters are in place. Panelist Linea Wilson, MBA, CHFP, managing partner, Talavay Consulting Group, noted several potential compliance challenges. As AI will have access to sensitive patient information, there should be protections and policies in place for AI data management and cybersecurity. She emphasized that when training AI, stakeholders should ensure that it’s free from bias and discrimination. Furthermore, it should be monitored, with stakeholders having access to understand how the technology functions and makes decisions, allowing for more transparency.

In terms of AI regulation, Colborn described the current status as the “wild west.” There are multiple sources of authority involved, including US Congress, the US Food and Drug Administration, state governments, boards of pharmacy, and the courts. Although there is low consensus on these institutions’ approaches, they all have a great interest in regulating AI. For instance, 60 bills in 23 states have been introduced, along with other federal legislation.

“We need a nation-wide solution for AI legislation,” said Jeff Mesaros, PharmD, JD, MS, president of The Mesaros Group, LLC. According to Dr Mesaros, since the COVID-19 pandemic, technology tools in health care, such as telehealth, have advanced much faster than normal. As the outgoing president of the National Association of Boards of Pharmacy (NABP), Dr Mesaros shared how the organization’s Research and Innovation Institute is working to keep up with these technological changes and reduce barriers to AI adoption.

One such barrier is the information gap between state boards of pharmacy, regulated parties, and patients, which could lead to technology outpacing regulation or board of pharmacy allowances. The institute aims to close this gap by “acting as an independent, impartial connector, facilitator and/or research partner for member boards of pharmacy, regulated entities and third parties to share, study and evaluate technology and digital health concepts.” NABP will also share collected data with its members and industry stakeholders to help with informed decision-making.

While AI legislation evolves, Wilson encouraged stakeholders prepare to abide by future regulations. She advised implementing a “nimble AI compliance framework” to ensure that policies—such as patient privacy—are consistently updated, as this could become a liability issue as well.

Reference

Colborn A, Wilson L, Mesaros J. The legal landscape of AI in managed care pharmacy: compliance, ethics, and future trends. Presented at: AMCP 2025; March 31-April 3; Houston, TX.