On April 9, legislators, Auditor General DePasquale and members of the PA Pharmacists Association held a press conference at the Capitol in support of legislation that adds accountability and transparency to prescription drug pricing to assist community pharmacists across the state.
Patricia Epple, CEO of the PA Pharmacists Association, said members of the Association put patients first, adding 86 percent of Americans live within five miles of community pharmacies and visit those pharmacies on average of at least 35 times per year.
Auditor General Eugene DePasquale said a bipartisan coalition supports a legislative package to assist community pharmacists saying it is critical to have competition at a retail level and that no one believes that the cost of prescription drugs is too low.
DePasquale explained that the current system is pricing people out of affording medication they need, and supporting this legislative package will help change that.
In December, DePasquale issued a special report, “Bringing Accountability and Transparency to Prescription Drug Pricing,” which noted that Pennsylvania taxpayers paid $2.86 billion to PBMs for Medicaid enrollees in 2017. That marked an increase of 100 percent in just four years, up from $1.41 billion in 2013.
In February, he issued a follow-up report focused on manufacturer rebates passed behind the scenes between drug makers, PBMs and insurance providers – never reaching consumers.
Rep. Robert Matzie (D-Beaver), co-chair of the Pharmacy Caucus, explained that local pharmacies are a resource for health information for people in the southwestern part of Pennsylvania. He asserted that they are being “driven out of business” by pharmacy benefit managers (PBMs).
Sen. Judy Ward (R-Blair) gave her support for the over-300 pharmacists and pharmacy students participating in today’s pharmacy legislative day. She explained that the local pharmacies are small enough that they do understand the lives of everyone in the communities they serve.
Epple explained that the Medicaid reform bills which are part of the current legislative package will assist the taxpayer and help the community pharmacist remain in business. She asserted that community pharmacists need legislative support to get something done.
Representatives Seth Grove (R-York) and Doyle Heffley (R-Carbon), and Sen. John Yudichak (D-Luzerne) were also in attendance.
Bill Package
The bills in the prescription drug/community pharmacists package include--
-- House Bill 941 (Heffley (R-Carbon) and (Matzie-D-Beaver) requires transparency in the Pharmacy Benefit Managers (PBMs) dealings with the Managed Care Organizations and the Department of Human Services. Almost 90 percent of Pennsylvania Medicaid patients are served by managed-care companies that contract with the state. In turn, those companies contract with PBMs for the management of their pharmacy programs. This legislation would require transparency between the payments from the MCOs to the PBMs and then to pharmacies. This legislation would also ensure fair reimbursement rates for community pharmacies.
-- House Bill 942 (Grove-R-York) would add one member from all four caucuses and two additional community pharmacists to the Pharmacy & Therapeutics Committee (P&T). The P&T committee establishes the drug formulary lists for the Medicaid program.
-- House Bill 943 (Gaydos-R-Allegheny) would remove gag clauses in Medicaid. When PBMs contract with pharmacies, many times the contracts contain gag clauses, which prohibit a pharmacist from disclosing information to their patients that could substantially reduce the patient’s out-of-pocket costs for their prescription medications. Additionally, some PBMs are prohibiting pharmacists from disclosing information to legislators and other officials and this bill would prohibit those gag clauses as well.
-- House Bill 944 (Fritz-R-Wayne) would allow the Auditor General to audit all contracts between the Department of Human Services and the Managed Care Organizations as well as the contracts between the MCOs and the PBMs.
-- House Bill 945 would prevent a Managed Care Organization from using a Pharmacy Benefit Manager for Medicaid if the PBM is part of a larger company that also owns retail pharmacies.
Visit the PA Pharmacists Association website for more on their legislative initiatives.
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