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Pennsylvania House of Representatives
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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: December 18, 2023 09:03 AM
From: Representative Jessica Benham and Rep. Valerie S. Gaydos
To: All House members
Subject: Pharmacy Benefit Managers (PBMs) Legislation
Our Commonwealth’s community pharmacies are faced with accelerating changes in the health care market that have brought new challenges, including reimbursement costs that do not cover the cost that they incur to purchase drugs.  For some of our pharmacies, these challenges threaten their very survival.
Our pharmacies are increasingly dealing with Pharmacy Benefit Managers (PBMs). To assist our pharmacies, we are introducing legislation that will give the Commonwealth more oversight over PBMs. This legislation will direct the Insurance Department to develop a process for hearing and resolving pharmacy complaints against a PBM. PBMs shall report to the department the amount of rebates and payments received from drug manufacturers, and how those rebates and payments were distributed by the PBM.
The legislation will also limit or ban several practices by PBMs, including patient steering, spread pricing and retroactive recoupment of money paid by the PBM to the pharmacy.
Changes in the health care market, along with concerns over costs, have resulted in new methods of delivering services to customers, which, in turn, has led to new relationships among the entities that deliver those services. This legislation will give Pennsylvania the ability to better protect our Commonwealth’s pharmacies, which are vital to their communities. This will also help our residents who depend on prescription drugs. Please join us in co-sponsoring this legislation.

Introduced as HB1993