Rx Roundup for Sept. 22, 2023

National and state news affecting independent pharmacies

National Pharmacy News

This week, PBM’s were in the spotlight at the Capitol. During the House Committee on Oversight and Accountability hearing about PBMs, lawmakers from both sides of the aisle agreed that PBMs have too much power and very little transparency.

“Instead of fierce competition, now just three PBMs control 80% of the market, and each of the three major PBMs is owned by a major health insurer and owns or is owned by a pharmacy,” stated committee Chair James Comer (R-Ky.). “This means that when they negotiate with a health insurer, they are either negotiating with themselves or one of their direct competitors. The committee has made it a priority to expose the anticompetitive tactics by PBMs that are increasing healthcare costs for Americans and harming patient care.” Read more about the hearing.

U.S. map for Rx Roundup blog post Sept. 22

State Pharmacy News

Florida: Florida lawmakers approved the rules to implement several provisions of the Prescription Drug Reform Act (SB 1550). The rules increase accountability among PBMs. They include all application forms for PBMs seeking to operate in Florida in 2024. Any PBM that attempts to continue operating in Florida next year, and has not been approved as an insurance administrator, can be fined up to $10,000 per violation per day. Read more.

Washington: The Washington State Pharmacy Association (WSPA), NCPA, and NACDS are celebrating a settlement of a six-year lawsuit with the state of Washington. The state agreed to these terms among others:

  • Conduct a cost of dispensing study to move to cost-based dispensing fees
  • Provide more than $60 million in retroactive payments to pharmacies in Washington State’s fee-for-service Medicaid program
  • Use, for now, Oregon’s cost-based dispensing fees and tiers from July 1, 2023, going forward, until a new cost-based dispensing fee obtains necessary state and CMS approval.

Read more.

Categorized as Updates