PBM Transparency Bill Assigned to Senate Appropriations and Revenue Committee
OUR KPhA continues to work on
Senate Bill 117 sponsored by Senator Max Wise. While this legislative is of special importance to independent pharmacists, it is vital for the entire profession in that what threatens one segment of the profession hurts us all. This legislation would improve Kentucky's existing MAC transparency legislation to ensure that it is fully implemented as it was intended when originally passed in 2013. The legislation would require Pharmacy Benefit Managers (PBMs) to be licensed by the Department of Insurance and it would require PBMs to enhance their existing appeals processes and increase MAC transparency. This is KPhA's top legislative priority.
Although Kentucky Medicaid has been subject to MAC transparency legislation since 2013, current claims focus on the cost to enact
SB 117. As a result, some senators have become concerned about the fiscal impact of the legislation. Arguably, the only reason that there would be a cost increase is if Medicaid admits that it is underpaying pharmacists in Kentucky based on contracts signed with the PBMs. The Senate Chair of the Appropriations and Revenue Committee, Chris McDaniel (R-Taylor Mill), is currently waiting to get all of the fiscal analysis back from state agencies in order to fully analyze the budgetary impact of
SB 117.
The Pharmacy Benefit Managers (PBMs) continue to oppose language in the legislation that would allow the Kentucky Department of Insurance (DOI) to request their methodology in order to make determinations in appeals disputes. KPhA and our pharmacy partners have agreed that this information will be kept confidential by DOI. PBMs contend that they will immediately sue the state if the language is included in
SB 117. Other work continues by KPhA and our pharmacy partners to analyze and respond to the fiscal impact statements.
KPhA expects
SB 117 to be heard on Tuesday in the Senate Appropriations and Revenue committee.
Bill would Prohibit Mandatory Mail Order and Define Specialty Drugs
House Banking and Insurance Committee Chair Jeff Greer (D- Brandenburg) filed
HB 458 which would prohibit insurers from requiring patients to switch to mail order pharmacy from retail pharmacy. It also would prohibit insurers from requiring different cost-sharing arrangements for mail order.
House Bill 458 would define the term "specialty drug," which would make Kentucky the first state in the country to do so. Recently, insurance companies have started placing drugs on specialty lists that retail pharmacies have been safely dispensing. This is a growing problem for retail pharmacies, and there is no uniform definition among insurers for specialty drugs.
House Bill 458
would limit the definition of a specialty drug to those drugs that would require special handling and patient education by the drug manufacturer or those that are on a FDA drug shortage list. The bill has been assigned to the House Banking and Insurance Committee and is expected to be heard in committee next week.