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House of Representatives
Session of 2017 - 2018 Regular Session


Posted: March 26, 2018 04:17 PM
From: Representative Doyle Heffley
To: All House members
Subject: Unfair Pharmacy Reimbursement
In the near future, I will be introducing legislation addressing inadequate reimbursement rates for independent pharmacies.

Almost 90 percent of Pennsylvania Medicaid patients are served by managed-care companies that contract with the state. In turn, those companies contract with pharmacy benefit managers (PBMs) for their pharmacy programs to decide which drugs will be covered and how much to reimburse the pharmacies that fill the prescriptions.

Over the last few months, I continue to hear from my local pharmacies about severe cuts to pharmacy reimbursement rates by specific PBMs, especially Medicaid. For many medications, payments are well below cost, forcing pharmacies to operate in the red. These pharmacy reimbursement cuts make
it extremely difficult for the 900 independent pharmacies in our Commonwealth to maintain inventory and serve our most vulnerable citizens.

I share the pharmacists' frustration regarding this issue. In fact, I even inquired about this recently at the Department of Human Services budget hearing and urged that there be transparency in contracts to ensure reimbursement rates are adequate. If reimbursement rates continue to diminish and pharmacies continue to operate substantially below cost, they will have to close their doors and patients will suffer. Therefore, I am planning to introduce legislation addressing this issue.

I hope you will join me in cosponsoring this important legislation.

Introduced as HB2212