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08/13/2022 03:26 PM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20210&cosponId=35859
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House of Representatives
Session of 2021 - 2022 Regular Session

MEMORANDUM

Posted: June 11, 2021 10:44 AM
From: Representative Jonathan Fritz
To: All House members
Subject: Authority of the Pennsylvania Auditor General to Audit Subcontracts with Pharmacy Benefit Managers
 
In the near future, I will be introducing legislation allowing for a full-scale audit of managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid.

Almost 90 percent of Pennsylvania Medicaid patients are served by managed-care companies that contract with the state. In turn, those companies contract with PBMs for their pharmacy programs to decide which drugs will be covered and how much to reimburse the pharmacies that fill the prescriptions. According to the Department of Human Services, Pennsylvania taxpayers pay $3 billion annually to PBMs for Medicaid enrollees.

Since contracts between managed-care companies and PBMs are not signed directly with the state and are instead subcontracts, there is no provision requiring that they be made available for the Department of the Auditor General to review. I believe there is a need for greater transparency, which is why I am introducing this legislation to ensure taxpayer dollars are being handled effectively and efficiently.

I hope you will join me in co-sponsoring this important legislation.  Thank you. 



Introduced as HB1630