Legislative Madness

“Here’s how I’m going to beat you. I’m going to outwork you. That’s it. That’s all there is to it.” — Pat Summitt, University of Tennessee Women Lady Volunteers (1974 to 2012)

Legendary Coach Pat Summitt had no idea how hard the army of pharmacy owners and patients would be working to overcome the PBM mafia, but hard work never scared a small business owner. We can’t outspend them, since they are bankrolled by fees no one can explain and just underpay their competition to pad their pockets. Owners must get LOUD and outwork them by having patients and their community networks reach out to tell them the importance of patient access and lower drug prices.

I think it might be easier to be a Certified NCAA Bracketologist than try to follow spreadsheets tracking pending PBM legislation this year. Whether you are in a state that is working on one of your first pieces of PBM reform or building on prior year’s successes, pharmacy owners and advocates across the country are continuing to fight back against egregious PBM tactics. There has been action on several PBM reform bills at the state level over the last few weeks. I am highlighting a few that have made substantial progress, and others that need every pharmacist and patient in their state to speak out against Goliath.

Kudos to the 3 states that have bills that have made it through both state legislative chambers and to the Governor’s Desk. Arkansas Governor Sanders has signed Act 350, requiring PBMs to reimburse pharmacies with 7–14 days for electronic claims and 30 days for paper claims, or face a 12% penalty. Georgia’s HB 196 passed both chambers, and has been sent to Governor Kemp’s desk. This bill will provide a $11.50 dispensing fee for independents and $10.50 for other pharmacies for state health employee plans and state university employee plans. This would help save a minimum of $11M to the state in prescription drug costs. Social media has been abuzz since Virginia passed the Save Local Pharmacies Act. Legislators, pharmacy owners, and Cost Plus Drugs Owner Mark Cuban even weighed in on wanting Governor Younkin to sign this bill soon. We hope the General Assembly will reject the recently proposed amendments and sign the Save Local Pharmacies bill by the April deadline.

We are cheering on our members in traditional powerhouse states such as Arkansas, who has consistently led the way in PBM reform, and fighting a tidal wave of opposition ads and hit pieces. New York is back with their own bill to prohibit conflict of interest by owning a pharmacy and a PBM.

The Cinderella stories of this session would include Mississippi and Alabama. Mississippi’s bill passed the Senate, and is currently being discussed in the Conference committee to hopefully go back to the House floor for a vote. It has been truly inspiring to watch these independent pharmacies work together to educate legislators on the importance of passing PBM reform now. Alabama’s SB 252 has passed the Senate, and has pharmacists and patients across the state engaging their legislators on social media and at the Capitol.

We also have legislation on the bubble in Minnesota, Illinois, Texas, Missouri, North Carolina and a few other states. Stay tuned to our social media for updates and help us spread the word when a call to action in those states is needed. Thank you all for the hard work it took to get us to this point in these marathon legislative sessions!

“There is a point in every contest when sitting on the sidelines is not an option” — Dean Smith, University of North Carolina Tar Heels (1961–1997)

State Legislation to Watch:

Arkansas HB 1150

What it is: Prohibition of Insurance or PBM-Owned Pharmacies

Why it’s important: Under HB 1150, healthcare conglomerates and their PBMs would be prohibited from obtaining permits allowing them to operate pharmacies of any form in the state of Arkansas.

New York A06546

What it is: This bill prohibits any person, firm, corporation, or association from simultaneously owning, operating, or controlling both a pharmacy and a pharmacy benefit manager (PBM).

Why it’s important: New York calling out conflicts of interests between pharmacies and PBMs will help dismantle some of the monopolistic practices in the market.

Mississippi HB 1123

What it is: PBM Reform

Why it’s important: This is an updated bill number for PBM reform legislation that includes PBM transparency measures to keep patient access to local pharmacies across the state.

Alabama SB 252

What it is: The Community Pharmacy Relief Act

Why it’s important: This bill would prohibit pharmacy benefits managers from reimbursing independent pharmacies less than the amount paid by the Alabama Medicaid Agency.

Lauren Young, PUTT VP