The Other March Madness: PUTT's PBM Legislation Scouting Report

Mar 4, 2022

As March is storming "in like a lion", recent developments at both the state and federal levels may have PBMs feeling buffaloed. And while February's FTC hearing was deadlocked thanks to the “no” votes of 2 FTC commissioners. PUTT, along with multiple other advocacy organizations responded immediately with statements condemning the move. We firmly believe the resulting FTC comment period on PBM practices is a direct result of the hearing's moving testimony given by pharmacists, doctors, and patients, and urge everyone to submit their experiences and data to the FTC for consideration.

Community Oncology Alliance (COA) released their bombshell white paper focused on the adverse effects PBM tactics have on patients and the treatment of cancer. The data, conducted as a study in conjunction with 3Axis Advisors, is further proof of what we all know to be true about PBM abusive practices poisoning the healthcare industry. We can only hope that legislators on all sides take the information to heart.

Speaking of legislators, PUTT Executive Director, Monique Whitney, PUTT past president Teresa Dickinson, and a group of local Arizona pharmacy owners met this week with Senator Krysten Sinema’s (D-AZ) staff to brief the Senator on the importance of PBM accountability and transparency in healthcare reform. (FYI: PUTT members can access a copy of the packet presented to Senator Sinema’s office by visiting the Members’ Library section of our website or by clicking here.)

Last week the DOJ filed suit against the proposed UnitedHealthcare Change Healthcare merger - and while it’s not legislation, it is forward motion. In a statement, DOJ Principal Deputy Assistant Attorney General Doha Mekki commented that “Unless the deal is blocked, United stands to see and potentially use its health insurance rivals’ competitively sensitive information for its own business purposes and control these competitors’ access to innovations in vital healthcare technology,” further proving that the federal government may actually be listening when it comes to PBM unethical practices within the web of vertically-integrated healthcare.

At the state level, progress is marching onward in the reform fight. These are some of the states we're watching:

Michigan passed Representative Calley’s HB 4348 and it was signed by Governor Gretchen Whitmer. This bill has multiple steps to combat PBM practices and add transparency and education for Michiganders. CVS Health pulled out all the stops lobbying for a veto from the Governor, so kudos to the Michigan Independent Pharmacists & advocates for their hard-won success!

Tennessee’s legislature is in discussion regarding enforcement of their 2021 bill in a House Committee. This is important for any state to look at who has had recent legislation passed but PBMs have found loopholes in the law. Tennessee SB1617/HB1398 - sponsored by Senator Shane Reeves, a pharmacist - addresses not allowing pharmacies to be paid below acquisition cost of a drug. Amazing but not surprising to hear, 430+ appeals have been filed in the first 9 months after this law took effect, and the 35 different appeals processes by PBMs are all lacking the criteria the state’s Department of Insurance required per this legislation.

Florida moved Representative Toledo’s HB 357 out of committee and it passed the House with a unanimous floor vote. Its companion bill SB 1476 also cleared the Appropriations committee unanimously and is now being sent to the Senate floor. HB357/SB1476 is an effort to close loopholes and enforce registration of PBMs with the state’s Office of Insurance Regulation, which has been required (but blatantly ignored) since the 2018 amendment to the Florida Pharmacy Act.

Georgia’s legislature unanimously passed Representative Knight's HB1351 out of the House Special Committee on Access to Quality Healthcare. This unique bill MCO carve-out bill now moves on to the House Rules committee and is definitely one to watch.

The Iowa legislature’s PBM reform bill passed through the state Senate Subcommittee & House committee. Companion bills SF 2092 & HSB 623 focus on patient steering, copay accumulators, and fair reimbursements.

Illinois moved their MCO Audit bill (SR 792) forward out of committee via a Senate Resolution.

We’re also watching Indiana, Nebraska, Wyoming, Wisconsin, Missouri, Arizona, Maryland, Oklahoma, & Kentucky for bill progress.

Finally - and definitely not to be forgotten! - the CMS comment period deadline is swiftly approaching! We urge everyone to send CMS your thoughts and experiences on DIR, and include data evidence wherever possible. The deadline for submissions is Monday, March 7th.