Pennsylvania Legislators Seek to Reform Pharmacy Benefit Manager Practices Amid Growing Concerns

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SCRANTON, PA — In a revealing hearing conducted by the House Majority Policy Committee at the Scranton Counseling Center, independent pharmacy owners voiced significant concerns over the financial challenges they face due to the practices of pharmacy benefits managers (PBMs). The session, aimed at shedding light on the hurdles encountered by independent pharmacies, highlighted how PBMs are affecting drug prices for consumers, particularly seniors and people with disabilities.

State Rep. Kyle T. Donahue, who hosted the hearing, pointed out a systemic issue where PBMs, intended to negotiate reasonable prescription prices through Medicaid, are instead contributing to escalating drug costs without passing savings onto consumers. “In this case, the PBMs – a third-party – is not only pocketing taxpayer dollars but they are also driving the escalation of drug prices,” Donahue stated, emphasizing the need for immediate reform to correct these abuses.

The testimony from pharmacy owners detailed how PBMs, as intermediaries between insurers and pharmaceutical manufacturers, are securing billions in taxpayer dollars, thereby inflating Medicaid expenses and increasing overall drug prices. This behavior has prompted both lawmakers and the Pennsylvania Pharmacy Association to advocate for legislation to overhaul PBM practices.

House Majority Policy Chairman Ryan Bizzarro expressed disgust at the situation, criticizing PBMs for underpaying local pharmacies and shortchanging seniors. “It’s sickening behavior, and it’s one reason reform is needed,” Bizzarro remarked, highlighting the urgency of addressing these exploitative practices.

Among the proposed reforms is H.B. 1993, introduced by state Rep. Jess Benham, which aims to establish guidelines and protections for pharmacies against PBMs. The bill seeks to restrict or eliminate several contentious practices, including patient steering, spread pricing, and retroactive recoupment, while also instituting a process for pharmacies to lodge complaints against PBMs through the state’s Insurance Department.

Rep. Benham emphasized the widespread impact of the current practices, pointing out that community pharmacies across Pennsylvania, from rural areas to cities, are facing closure. “Unless we enact reforms, we will continue to lose these trusted institutions,” Benham said, underscoring the critical role of local pharmacies in providing essential, personalized services to their communities.

The testimonies of Eric Pusey and Tom DePietro, owners of Better Health Pharmacy & Wellness and DePietro’s Pharmacy respectively, highlighted the existential threat faced by family-owned and small local pharmacies. They described how predatory practices by PBMs are pushing these vital community resources out of business, detrimentally impacting both the proprietors and the patients who depend on their services.

The hearing emphasized the urgency of legislative action to address the imbalances created by PBMs in the healthcare system, advocating for a level playing field that would safeguard independent pharmacies and ensure continued access to personalized, vital healthcare services for Pennsylvanians.

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