NCPA's state government affairs team tirelessly tracks and engages with state legislation and regulation across the country, with our priorities including comprehensive PBM reform, PBM regulation enforcement, and Medicaid managed care reform. Here's a breakdown of our recent state government affairs activity relating to pharmacy reimbursement.
- SB 20, the Kansas Consumer Prescription Protection and Accountability Act, has passed both chambers and heads to the governor. With provisions previously contained in SB 360, SB 20 includes strong pharmacy audit protections and creates a commercial market reimbursement floor of NADAC plus the greater of $10.50 or the state Medicaid professional dispensing fee for plans not subject to ERISA preemption. NCPA has provided ongoing support to members, the state association, and policymakers throughout the hard-fought legislative process.
- NCPA submitted comments in support of Tennessee SB 2040 in advance of a Senate Finance, Ways and Means Committee vote. The bill, which would prohibit PBMs from owning pharmacies, was passed with amendments by a 9-2 vote and now heads to the Senate floor.
- NCPA signed onto an industry letter urging Mississippi lawmakers to support the version of HB 1665 with wide-ranging provisions addressing reimbursement, spread pricing, and drug pricing transparency. In a follow up letter, NCPA communicated its specific support for using the state Medicaid fee-for-service methodology as a benchmark for commercial market reimbursement. Although the bill died as the legislative session concluded, stakeholders hold out hope for a special session to continue their efforts.
- NCPA wrote to the governor of West Virginia seeking his signature on HB 5430. As reported previously, the bill addresses PBM reform within the Public Employee Insurance Agency and, for Medicaid, requires a new cost of dispensing survey every three years thereafter.
- NCPA submitted two witness slips at a recent Illinois House Health Care Availability and Accessibility Committee hearing. One was to oppose drug pricing legislation HB 1443, which would authorize a Prescription Drug Affordability Board to create an Upper Payment Limit without recognition of pharmacy reimbursement. The other slip was to support HB 1018, which addresses patient steering and prohibits PBMs from reimbursing their owned or affiliated pharmacies more than others. NCPA also submitted a slip for an Executive Committee hearing of HB 4761 with NADAC+ provisions.
- NCPA provided drug pricing insights to stakeholders in Rhode Island to oppose or amend S. 2384 as it was heard in committee with a proposed Maximum Fair Price benchmark.
- NCPA helped stakeholders in Hawaii with insight about fair pharmacy audits as work continues on HB 1643 pertaining to audit protections.
- NCPA's eyes are on the enactment of Florida HB 697, legislation pertaining to the state's Program of All-Inclusive Care for the Elderly with several pharmacy-related provisions. The new law prohibits PBMs from reimbursing their owned or affiliated pharmacies more than others and allows pharmacies to decline to dispense medications below actual acquisition cost.
- New Jersey A. 1502, the Patient and Provider Protection Act, was advanced by the Assembly Financial Institutions and Insurance Committee. The bill creates a commercial market reimbursement floor of NADAC plus the state Medicaid professional dispensing fee, assigns fiduciary duty to PBMs, and addresses both patient steering and spread pricing.
A series of reimbursement-related bills cleared the Senate chamber in Oklahoma. SB 2074, with a commercial market floor of NADAC plus the state Medicaid professional dispensing fee, received a 37-3 favorable vote. SB 1500 and SB 2007 address retroactive claims adjustments and appeals processes respectively. Meanwhile, HB 3538, which would prohibit PBMs from owning pharmacies, cleared the House with a 93-2 vote.
Please check out the NCPA state legislative tracking webpage, where you can see all the bills we are following and connect to our Advocacy page.
