State representatives to discuss pharmacy benefit manager regulation at roundtable event
Western Pennsylvania state representatives will hold a roundtable discussion Thursday at Westmoreland County Community College to discuss proposed regulations on pharmacy benefit managers with regional pharmacy stakeholders.
State Reps. Jessica Benham, D-Pittsburgh and Eric Nelson, R-Hempfield, will host the discussion from 8 to 10 a.m. to talk about Benham’s bipartisan bill, which aims to address complaints from independent pharmacy owners across the state. The event will be held at 145 Pavilion Lane in Youngwood, at the Student Achievement Center.
Pharmacy benefit managers are third-party intermediaries between drug manufacturers, pharmacies and insurance providers. They reimburse pharmacies for the prescriptions customers buy with insurance.
Independent pharmacy owners have contended that the reimbursements are far less than the actual cost of medications. Low reimbursements can cause pharmacies to lose money on each transaction, especially on new, expensive brand-name medications like Ozempic.
Mainline Pharmacy, which closed nine of its 11 locations earlier this year, said it lost more than $350,000 on about 17,500 prescriptions filled at the beginning of 2024 because of low benefit manager reimbursements.
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Benham’s bill, House Bill 1993, would place more regulations on pharmacy benefit managers at the state level. It would direct the state insurance department to develop a process for hearing and resolving pharmacy complaints against the companies.
The bills would ban certain practices in benefit manager contracts, including “patient steering,” in which a pharmacy benefit manager directs a patient to use a preferred pharmacy by approving only certain pharmacies and lowering co-pays for the pharmacies that the benefit manager prefers.
Another prohibited practice would be “spread pricing,” in which benefit managers reimburse a pharmacy for a prescription and then bill an insurer or an employer that provides health insurance a higher price for the same prescription.
Benefit managers also would have to be transparent about the amounts of rebates and payments they get from drug manufacturers as well as how they distribute them.
Julia Maruca is a TribLive reporter covering health and the Greensburg and Hempfield areas. She joined the Trib in 2022 after working at the Butler Eagle covering southwestern Butler County. She can be reached at jmaruca@triblive.com.
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