Pennsylvania legislators introduce measures tightening PBM regulation

Pennsylvania lawmakers have introduced separate bills addressing "gag orders" that prevent pharmacists from sharing full cost information with patients, as well as the prices that PBMs set for pharmacies versus what they collect from Medicaid. Rep.

Pennsylvania lawmakers have introduced separate bills addressing "gag orders" that prevent pharmacists from sharing full cost information with patients, as well as the prices that PBMs set for pharmacies versus what they collect from Medicaid. Rep. Judy Ward (R-Blair County) is sponsoring House Bill 2211, which would forbid PBMs from including "gag order" contract clauses. Rep. Doyle Heffley (R-Carbon County), meanwhile, on June 6 introduced a bill calling for more transparency in PBM pricing. Independent pharmacists complain that PBMs keep cutting their reimbursements—sometimes to levels below a pharmacy's costs to get the drugs—while also mandating how much the pharmacy can charge the customer. "We get take-it-or-leave-it contracts shoved down our throats," said one South Hills pharmacist who asked not to be identified because of his concern that a PBM would target his store with claim audits. "The public does not know what a PBM does and I'm not sure they even care. But what they do care about is having their medications priced fairly," said Patricia Epple, CEO of the Pennsylvania Pharmacists Association. PBMs can tell a pharmacy how much the pharmacist can charge, Epple said, while also pressuring drug manufacturers "to give them more rebates, which they keep. They are not passing those along to the consumer."