PBM reform bills off to a good start

NCPA February 23, 2022

  • Washington: HB 1813, a patient choice bill, unanimously passed the House and is now in the Senate. Among other patient protections, the bill would address PBM conflicts of interest by prohibiting a PBM from requiring a patient to utilize a mail-order pharmacy and from reimbursing PBM-affiliated pharmacies at higher rates than non-affiliated pharmacies.

  • Mississippi: The Mississippi House of Representatives passed Mississippi HB 733 which now heads to the state senate. This legislation requires pharmacies to be reimbursed at a rate no less than the National Average Drug Acquisition Cost plus $11.29 (state Medicaid professional dispensing fee) for commercial claims. This provision is similar to a provision passed last year in West Virginia and legislation currently being considered in Iowa and New Hampshire. Additionally, this legislation would require PSAOs to be licensed in the state of Mississippi.