This month in state advocacy news, we saw a group of state insurance commissioners outlining new rules auditing PBMs, the Illinois governor pushing for PBM reform, and an NCPA-supported PBM reform bill in Indiana clear a major hurdle, among other developments.
Here's a breakdown of the news:
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NAIC market conduct draft underway: The National Association of Insurance Commissioners began the drafting process for a new chapter dedicated to auditing PBMs in its market conduct manual. NCPA will be participating in all five working groups that were created to inform the draft. The new chapter is part of the NAIC PBM Regulatory Issues Work Groups' charges for 2024, along with a strengthened engagement of PBM compliance and enforcement.
- Illinois Gov. Pritzker gears up to tame PBMs: In his State of the State address on Feb. 19, Illinois Gov. J.B. Pritzker (D) dedicated significant time and attention to the needs of independent pharmacies and the importance of reforming PBMs. Watch his comments here. NCPA looks forward to supporting the Illinois Pharmacists Association's engagement on the Prescription Drug Affordability Act.
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PBM reforms clear the Indiana State Senate: SB. 140, PBM reform legislation spearheaded by the Indiana Pharmacy Association, passed the Senate on Feb. 20 with near unanimous support. Having gone through a series of amendments, the bill currently proposes the greater of a pharmacy benefits manager's reimbursement to their own affiliate (by NDC) or actual acquisition cost, plus a professional dispensing fee equal to the Medicaid fee-for-service program's. The amended bill also prohibits a health carrier from contracting with a PBM in which they have an ownership interest and prohibits a PBM licensed in Indiana from having an ownership interest in a pharmacy. You can find more on this at the Indianapolis public radio station WFYI.
- NCPA sends letters in support of improving payment models and expanding access to patients:
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NCPA submitted a letter of support for Hawaii's SB. 1245, a bill that requires public and private plans within the state to reimburse for services provided by licensed pharmacists at the same rate for services rendered by another provider.
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In California, the state's Department of Healthcare Services solicited public comment on regulations regarding AB 1114 (2016), titled "Medi-Cal: Pharmacists Services," a law passed that allows pharmacists within the state to be reimbursed for non-dispensing services at an 85 percent rate of other providers providing the same service under the state's Medicaid program. NCPA submitted comments to the DHCS requesting greater transparency from MCOs in contracts and publicly available reimbursement guidance for pharmacies.
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Immunization bill clears first chamber in Indiana on a unanimous vote: Pharmacists in Indiana hope to maintain momentum as Senate Bill 96, passed through the full Senate on a 49-0 vote and is now before the state's House of Representatives. SB. 96 expands the list of vaccinations pharmacists may administer by allowing all FDA-approved vaccines to be eligible rather than a specified list. The bill allows for the health commissioner to remove vaccinations otherwise approved by the FDA when the Indiana General Assembly is not in session. NCPA submitted a letter of support and looks forward to this expansion of patient access progressing through the House and being sent to the governor to become law.
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Mandatory off-label dispensing language in S.C. bill removed, will be heard again: The South Carolina Pharmacy Association is fiercely opposed to language mandating that pharmacists dispense medications without regard to their professional judgment and expertise. S. 54 will be heard on Feb. 26 by the Medical Affairs Committee within the South Carolina Senate. Section 4 of the bill limits the circumstances under which pharmacists may refuse to fill or refill prescriptions, compelling them to dispense a prescription that may compromise patient safety. Off-label prescribing and dispensing is a common and safe practice but completely removing a pharmacist from the process is a bridge too far. NCPA submitted a letter opposing this language in the earlier bill, S. 2, that was heard this year and has submitted a letter in opposition to similar legislation heard in Ohio last year.
