Lawmakers in states across the country are advancing legislation to regulate pharmacy benefit managers. New bills in North Carolina and Illinois aim to curb practices critics claim inflate drug prices and threaten survival of independent pharmacies.
Here are four notes:
- The North Carolina House and Senate each passed separate PBM reform bills in late April and early May, respectively, North Carolina Health News reported June 2. While both bills would increase transparency and reporting requirements, the House bill goes further by banning spread pricing and mandating minimum reimbursements for pharmacies, while the Senate bill focuses more on transparency and supply chain oversight.
- In Illinois, the state General Assembly approved a bill that bans PBMs from steering patients to affiliated pharmacies and would require full rebate passed through to the insurers, Capitol News Illinois reported May 30. The new legislation, which Gov. J.B. Pritzker vowed to sign, also imposes a per-member fee on PBMs to fund grants for struggling independent and rural pharmacies, with up to $25 million annually.
- Pharmacists in both states reported unsustainable losses from PBM reimbursement practices. In North Carolina, the state’s Central Pharmacy said it lost nearly $88,000 last year on prescriptions filled below the cost. Illinois pharmacists detailed being reimbursed less than the acquisition cost for some brand name drugs while PBMs paid their own affiliated pharmacies more.
- Connor Rose, a lobbyist for the Pharmaceutical Care Management Association, which represents a majority of PBMs, told Health News that PBMs are the only entities in the drug supply chain dedicated to lowering costs and claimed they save patients more than $1,000 per year on average.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.