March Madness: PUTT’s Legislative Roundup
Happy Legislative March Madness!
Many state legislatures are barreling towards the end of their Spring session, and it’s time for an update on what’s happening across the country in the fight for transparency against PBMs/PBCs. We analyze legislative committee hearings to see what new dirty tricks PBMs and their vertically integrated health plan comrades are using to try and fool our legislators this session, so we can provide our donors with resources and infographics to combat them.
If we were to create a bracket for PBM Reform bills at the state level, you would see perennial powerhouses such as Texas working to continue their success of previous sessions and expand on their PBM reform bills that were passed before. Texas’ HB 1919 sponsored by Rep. Tom Oliverson, passed in 2021 and builds on the Rutledge decision by including ERISA plans in the state’s purview. Opposition to this bill (including Texans for Affordable Healthcare, a PCMA spin-off group) is now waging a defensive onslaught to get the legislation repealed. As a physician, Dr. Oliverson understands first-hand the need for PBM reform. He knows patients are being harmed by legislative changes not being enacted or enforced, and is steadfast in his determination protect independent pharmacies and their patients.
Arizona and Minnesota may be the Cinderella stories of this year, as their PBM reform bills play out against CVS Caremark & United Healthcare/Optum in their respective home states. Arizona’s SB 1382 has passed out of committee. It requires all pharmacy benefit managers to obtain a certificate of authority to operate, and prescribes the Department of Insurance and Financial Institution’s roles, responsibilities and authority.
Minnesota’s fight against PBMs is being championed by a new power group of independents called the MNIndys; created by PUTT’s President, Deborah Keaveny. Minnesota had success a few years ago with the passage of 62W, but lack of enforcement has allowed PBMs to continue their manipulative practices. SF 2067 was recently heard in committee, and former Independent Pharmacy owner Deborah Leedahl powerfully testified as to the PBM practices that resulted in the sale of her store this month. Leedahl is without doubt our MVP for her commitment to telling her story and continuing the fight against PBM abuse of pharmacies and their patients!
Across the nation 340B organizations are popping up in opposition of Medicaid Carve-Out attempts. Please make sure you are educating your legislators to understand a win for independent pharmacy patients does not undercut 340B entities!
Don’t sleep on the progress being made in Oklahoma. The state is working to strengthen enforcement of their PBM reform laws and hold the Department of Insurance accountable for enforcing these regulations. HB1843 will move enforcement from the Insurance Commissioner’s office, to the Oklahoma Attorney General’s office. This will aid in enforcement of previous PBM reform legislation.
Unfortunately, not every session includes a win for the good guys. One buzzer beater that has people riled up is Wyoming. Governor Mark Gordon used his line item veto power to remove protections for independent pharmacies across the state in a bill that recently reached his desk. He regurgitated PCMA/Major Health Plan talking points that the line items could potentially raise costs. Supporters of SF 151 put their blood, sweat and tears into getting this bill to the Governor’s desk, only to have it taken away in the final seconds. Keep fighting in Wyoming — we’re behind you!
On the Federal level, there has been movement on S 127, the PBM Transparency Act of 2023 co-authored by Senators Grassley & Cantwell. This bill generally prohibits PBMs from engaging in certain practices when managing the prescription drug benefits under a health insurance plan, including charging the plan a different amount than the PBM reimburses the pharmacy. The bill also prohibits PBMs from arbitrarily clawing back reimbursement payments to pharmacies to offset changes to federally funded health plans, and discusses the FTC’s role in enforcing its provisions; which has caused some friction between both parties. It passed out of committee, but let’s hope the FTC component of this bill doesn’t allow for further delays.
Rep Buddy Carter announced another bipartisan reform bill that could be making its way around Capitol Hill. The Drug Price Transparency in Medicaid Act (HR 1613) saves taxpayers billions by eliminating the use of wasteful and predatory spread pricing by pharmacy benefit managers (PBMs) within government sponsored health plans. The program also establishes oversight of, and accountability for, PBM tactics that are threatening patient access to health care and increasing prescription drug spending in Medicaid programs.
We know that keeping up the heat is critical to continuing to rally support. Reach out to your legislators and let them know where you stand on bills in your state and at the Federal level. Don’t forget the keys to surviving to the next round of legislative madness:
- Continue to get LOUD;
- Encourage your patients to advocate for locally-owned pharmacy by reaching out to their legislators, and;
- Engage with PUTT to make an impact.
Until next time, Keep Pounding!
Lauren Young, Vice President, Pharmacists United for Truth & Transparency