Pennsylvania Medicaid reforms signed into law

NCPA December 1, 2020

Pennsylvania Gov. Tom Wolf (D) signed HB 941, which reforms the commonwealth’s Medicaid managed care program to protect beneficiaries, taxpayers, and local community pharmacies. Under the newly signed act, PBMs in the Medicaid program are prohibited from arbitrarily excluding a pharmacy from network participation, retroactively denying or reducing claim reimbursements, charging hidden pharmacy transmission fees, mandating that a Medicaid patient use the pharmacy of the PBM’s choice, and engaging in the costly practice of spread pricing. Additionally, the act requires the Legislative Budget and Finance Committee to conduct a study analyzing PBM reimbursement practices and other information impacting prescription drug pricing in the Medicaid program. Congratulations to the Pennsylvania Pharmacists Association, the Your Pennsylvania Community Pharmacies initiative, and all Pennsylvania community pharmacy advocates for this hard-fought win that will bring much-needed transparency to the Medicaid program!