Sure, all 50 states have passed some sort of PBM reform, but that doesn’t mean they’re done! We’re pleased to share news of more progress in Kentucky and Oregon, efforts we were proud to support.
In Kentucky, Gov. Andy Beshear (D) signed SB 188, critically important PBM reform legislation that requires pharmacy reimbursement in the commercial market and in most state employee plans of NADAC plus a professional dispensing fee effective Jan. 1, 2025. The dispensing fee will be $10.64 until Jan. 1, 2027. The Office of the Insurance Commissioner and the Board of Pharmacy will collaborate to do cost-of-dispensing surveys every two years to determine the dispensing fee, with their first survey result effective Jan. 1, 2027. The legislation also addresses network adequacy, limiting the role of mail order and ensuring patient access to pharmacies within either 30 miles or 30 minutes’ drive from their residence. Among its many provisions, SB 188 prohibits fees and other reimbursement reductions, including those made retroactively, prohibits lower reimbursement to non-PBM owned or affiliated pharmacies, and limits what PBMs can deem specialty drugs. We were pleased to advocate in favor of the bill.
In Oregon, Gov. Tina Kotek (D) signed HB 4149. Among its provisions, the law requires PBM licensure as well as transparency and reporting to identify spread pricing; adds audit protections; strengthens appeals processes; and prohibits reimbursement discrimination against 340B covered entities. It also requires the Department of Consumer and Business Services to hire at least one additional full-time employee to assist in PBM regulation. NCPA was glad to support the Oregon State Pharmacy Association’s efforts as the bill evolved over two years.
