The House passed House Bill 2212 introduced by Rep. Doyle Heffley that will give the Department of Human Services more oversight into the prescription reimbursements paid to pharmacies by the state Medicaid program through Pharmacy Benefit Managers making the whole process more open to scrutiny.
The House also passed House Bill 2211 introduced by Rep. Judy Ward that will prohibit the inclusion of gag clauses in community pharmacy contracts to help prescription patients reduce their out-of-pocket expenses.
Rep. Ward’s bill will free community pharmacists from the ‘gag order” they are under from companies serving as Pharmacy Benefit Managers and, for the first time, allow pharmacists to tell their prescription patients how to reduce their out-of-pocket expenses.
“Rep. Ward and I heard extensively about issues within the pharmacy community, including from several community pharmacy owners about unfair reimbursement rates for Medicaid patients,” said Rep. Heffley. “We believe our legislation – House Bills 2211 and 2212 – offers fixes to these issues that would benefit consumers and small businessowners.”
It was recently brought to light that some pharmacy benefit managers (PBMs) have been cutting reimbursements to community pharmacies for medications sold to patients on Medicaid. This practice has led to substantial financial difficulties for community pharmacies, which are typically locally owned family businesses.
Rep. Heffley’s House Bill 2212 would remedy the problem.
Many of Pennsylvania’s rural areas are served by community pharmacies. In Carbon County, for example, more than half of the pharmacies are locally owned and operated.
In addition, when PBMs contract with pharmacies, the documents may at times contain what is referred to as a “gag clause,” which prohibits pharmacists from disclosing information to a customer that could reduce their out-of-pocket costs for medications.
Rep. Ward’s House Bill 2211 would permit pharmacists to disclose drug information, allowing consumers to get the best price for their medications.
“What was shocking to me during my research of this issue is that for many less expensive or generic medicines, co-pays can often be more expensive than if the patient simply pays out-of-pocket and bypasses insurance,” said Rep. Ward. “Yet, sometimes a pharmacist is prevented from telling their customers about potential savings, which is a frustration to them when trying to help their customers.”
The bills now go to the Senate for action.
To learn more about these issues, visit the Pennsylvania Pharmacists Association website.
