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Senate of Pennsylvania
Session of 2021 - 2022 Regular Session


Posted: May 28, 2021 11:17 AM
From: Senator Ryan P. Aument
To: All Senate members
Subject: Audit of PBM Contracts
In the near future, I will be reintroducing legislation allowing for a full-scale audit of 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 paid nearly $3 billion to PBMs for Medicaid enrollees in 2017.
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 anyone to review, including the Department of the Auditor General.  Therefore, we do not know how this money is being used, regardless of the fact that these are taxpayer dollars.  I believe there is a need for greater transparency, which is why I am reintroducing this legislation to ensure taxpayer dollars are being handled effectively and efficiently.
This bill was introduced as SB 829 during the 2019-2020 legislative session and was co-sponsored by: Senators K. Ward, Vogel, Martin, Santarsiero, Muth, Schwank, Mensch, Folmer, Phillips-Hill, Stefano, Yaw, Blake, Sabatina, and Iovino.
I hope you will join me in co-sponsoring this important legislation.  If you have any questions regarding this bill, please contact Stephanie Buchanan at 717-787-4420 or sbuchanan@pasen.gov.

Introduced as SB917