Impedes a health plan’s ability to direct patients to a mail order pharmacy for chronic care medications.

PCMA Oppose WA SB5744

The talking points outline PCMA’s opposition to WA SB5744 which would create a mandate that health plans establish additional procedures to administer prescription drug benefits

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PBM-Pharmacy Snapshot

This document outlines the facts relating to the PBM-Pharmacy relationship. PCMA points out that Independent Pharmacies have significant bargaining clout via PSAOs and are highly

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KY – HB 458 Increases Health Care Costs and Creates Patient Safety Risk

These talking points explain that HB 458 prohibits mail-order only plans and prohibits providing patients a lower copay or coinsurance as an incentive to fill prescriptions through mail-order or specialty mail-order. HB 458 will have a direct and material impact on Medicaid, the Kentucky employees’ health plan, and the fully insured, private commercial insurance market in the state.

This bill limits a health plan’s ability to use mail-order programs removes the lowest cost pharmacy option available. Employers and health plans should have access to tools that manage prescription drug costs, without government intervention. When an employer or health plan contracts with a PBM to administer their pharmacy benefit, the employer maintains authority over the terms and benefit plan design. The employer or plan – not the PBM – makes decisions regarding cost-sharing requirements, mail-service, formulary, etc. HB 458 removes the option for the employer or health plan to use mail order and specialty pharmacy mail-order as cost savings tools.

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