In Review: Wrapping intensive negotiations led by PCMA this year, Pennsylvania senators have finally advanced an amended version of their PBM bill. The language creates a licensure requirement for PBMs, dictates parameters of how PBMs incent patients in retail and mail networks, requires that 95% of rebates be returned to plan sponsors, requires that various data be reported to the Pennsylvania Insurance Department for analysis and aggregate reporting, allows for pharmacists to practice at the top of their license by expanding their scope of practice, and new oversight of PSAO and their parent companies. PCMA was successful in keeping at bay policy proposals that would have mandated a pharmacy dispensing fee in the commercial and Medicaid markets, required an any-willing specialty pharmacy environment disrupting exclusive specialty networks, an attempt to include ERISA plans in the bill’s applicability, a commercial ban on spread pricing, a payment mandate to direct Pennsylvania to create its own NADAC-like reimbursement, and several other issues. We expect the House to concur with this newly amended version and Governor Shapiro to sign the bill this month as the legislature seeks to wrap up its budget work before breaking for the summer.

If you have any questions, please contact Heather Cascone at hcascone@pcmanet.org.