About PPA   |   Sign In   |   Join Now

Fair Reimbursement and PBM Transparency

 

Pharmacy Benefit Managers (PBMs) have no oversight in Pennsylvania.  PPA has been fighting for Fair Reimbursement and PBM oversight by introducing and lobbying a bill package in both the House and the Senate. While other legislation relating to these issues have been introduced that PPA supports, they are not part of the legislative package.  

 

 

 


 

 

House of Representatives Fair Reimbursement Package

 

Fair Reimbursement: HB 941

 

Overview: 

This bill provides the Department of Human Services the authority to review MCO and PBM contracts to account for taxpayer dollars.  It also prevents PBMs from mandating a specific pharmacy or giving incentives to patients to use a specific pharmacy, using spread pricing, charging transmission fees, or enrolling or disenrolling a pharmacist without cause and a written agreement from the pharmacist.  

 

Introduced by:

Rep. Doyle Heffley (R-122) and Rep. Rob Matzie (D-16)

Co-Sponsor Memo:

Click here to read the Co-Sponsorship memo

Legislation:

Click here to read the bill

Status:

Passed House unanimously (197-0) on 11/20/19.  Currently in Senate Health & Human Services Committee

Talking points:

Click here for talking points for Pharmacists, Technicians and Students

Issue Brief:

Click here for the issue brief to be provided to your Senator 

 

Pharmacy & Therapeutics Committee: HB 942

 

Overview:

While the Department of Human Services has currently added the two additional community pharmacists, we would like it put into law. This bill adds two additional community pharmacists to the pharmaceutical and therapeutics committee (P&T) and allows the Secretary of the DHS the ability to add more members if needed.

 

Introduced by: 

Rep. Seth Grove (R-196)

Co-Sponsor Memo:

Click here to read the Co-Sponsorship memo

Legislation:

Click here to read the bill

Status:

Passed House unanimously (197-0) on 11/20/19.  Currently in Senate Health & Human Services Committee

Talking points: 

Click here for talking points for Pharmacists, Technicians and Students

Issue Brief:

Click here for the issue brief to be provided to your Senator

 

 

 

Gag Clauses:  HB 943

 

Overview: 

This bill would allow the pharmacists to discuss price and alternatives with patients.

 

Introduced by:

Rep. Valerie Gaydos (R-44)

Co-Sponsor Memo:

Click here to read the Co-Sponsorship memo

Legislation

Click here to read the bill

Status: Passed House unanimously (197-0) on 11/20/19.  Currently in Senate Health & Human Services Committee

Talking points: 

Click here for the talking points for Pharmacists, Technicians and Students

Issue Brief: Click here for the issue brief to be provided to your Senator

 

Audit of PBMs:  HB 944

 

Overview:

This bill gives the authority to the PA Auditor General to audit PBMs in Medicaid

 

Introduced by: 

Rep. Jonathan Fritz (R-111)

Co-Sponsor Memo:

Click here to read the co-sponsorship memo

Legislation:

Click here to read the bill

Status:

Passed House unanimously (197-0) on 11/20/19. Currently in Senate Health & Human Services Committee

Talking points:

Click here for the talking points for Pharmacists, Technicians and Students

Issue Brief:

Click here for the issue brief to be provided to your Senator

 

 

Conflict of Interest:  HB 945

 

Overview:

This bill would allow the Department of Human Services to prevent an MCO from contracting with a PBM that has an

ownership interest in a pharmacy or a pharmacy that has an ownership interest with a PBM or a corporate affiliate

of the PBM. This bill has not been brought to a vote by the full House of Representatives and therefore is not part

of the bill package that moved to the Senate as of yet.

 

Introduced by: 

Rep. Stephen Barrar (R-)

Co-Sponsor Memo:

Click here to read the co-sponsorship memo

Legislation:

Click here to read the bill

Status:

Voted out of House Health Committee on 11/20/19.  Awaiting a vote by the full House

Talking points:

Click here for the talking points for Pharmacists, Technicians and Students

Issue Brief:

Click here for the issue brief to be provided to your Representative or Senator

 

Senate Fair Reimbursement and PBM Package

 

Fair Reimbursement: SB 825

 

Overview:

This bill

 

Introduced by:

Sen. Judy Ward (R-30)

Co-Sponsor Memo:

Click here to read the co-sponsorship memo

Legislation:

Click here to read the bill

Status:

Referred to the Senate Health & Human Services Committee on February 6, 2020

Talking points:

Click here for the talking points for Pharmacists, Technicians and Students

Issue Brief:

Click here for the issue brief to be provided to your Senator

 

 

 

 

Association Management Software Powered by YourMembership  ::  Legal