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Senate of Pennsylvania
Session of 2015 - 2016 Regular Session


Posted: February 17, 2015 04:16 PM
From: Senator Richard L. Alloway, II
To: All Senate members
Subject: Pharmacy Benefit Manager (PBM) Registration and Maximum Allowable Cost List (MAC) Transparency Legislation
Please join me in co-sponsoring legislation I will be introducing in the near future which would require PBMs to register with the Department of Health and provide MAC list transparency to pharmacies.

PBMs serve as middlemen between payers and pharmacies – and manage the pharmacy benefits for nearly 95% of all Americans with medical coverage. However, in Pennsylvania, PBMs do not have to register with any state agency or department. This legislation would establish basic registration requirements and will provide the avenue for oversight and require some accountability.

Sixteen states have some form of PBM licensure/registration/reporting laws and multiple other states have introduced or are in the process of introducing PBM licensure/registration/reporting bills.

In addition, this legislation would require PBMs to provide to prescription drug plan sponsors and pharmacies how MAC list pricing is determined and updated; while establishing an appeals process in which a pharmacist can contest a listed MAC price. A MAC list refers to an arbitrarily generated list of medications that establishes the maximum amount a prescription drug plan will pay for most generic drugs and brand name drugs that have generic versions available. Each PBM or payer establishes their own MAC list and sets the maximum amount they will reimburse a pharmacy, without regard to the price at which pharmacies may purchase the drug. More and more these established prices are below a pharmacy’s acquisition cost.

Introduced as SB669