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Pharmacy Testifies in Support of PBM Reform Legislation

Thursday, May 16, 2019   (0 Comments)
Posted by: Brian Sparks
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Pharmacy showed up in force at the State Capitol twice this week to testify in support of PBM reform, as the May 14 Senate Business and Commerce Committee hearing on HB 2817 was postponed until May 16. The bill, sponsored by Rep. Eddie Lucio III and Sen. Bryan Hughes, incorporates several provisions from HB 2231 by Rep. Tom Oliverson.

The bill requires description on how reimbursement is calculated; prohibits post-adjudication reduction of payments or recoupment of claims; prohibits PBMs from paying their affiliated pharmacies more; allows access to contract; provides legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals; prohibits PBMs from prohibiting pharmacies from delivering or mailing prescriptions; and prevents PBMs from requiring pharmacies to obtain additional accreditations and certifications beyond what is required by the Texas State Board of Pharmacy.

The legislation easily passed the House and is the strongest commercial PBM reform bill ever to make it this far in Texas. The Senate committee is expected to consider a vote on the bill today, needed before it can move to the full Senate for a vote. Please contact your state Senator and ask that they co-sponsor HB 2817.

Texas Pharmacy Association Members Carter High and John Hickman, along with Duane Galligher (representing the Texas Independent Pharmacies Association) and Miguel Rodriguez (representing the Texas Pharmacy Business Council) spoke about the PBM challenges faced by independent pharmacies.

High, president-elect of the Alliance of Independent Pharmacists of Texas, explained his challenges with patient steering to preferred and/or mail-order pharmacies, post-adjudication fees, and restrictions on mailing prescriptions. Hickman, representing TPBC, outlined how his pharmacy, founded in 1931, is “still family-owned, but today we’re totally PBM-controlled.” Galligher and Rodriguez addressed PBM contract transparency and onerous PBM accreditation requirements.

TPA Board Member Jay Bueche of H-E-B Pharmacy noted that "regional chains experience many of the same issues as independent pharmacy owners," saying that HB 2817 "provides minimal, common-sense oversight and adds a degree of transparency to an industry, pharmacy benefit managers, that is practically unregulated in Texas."

The Texas Association of Health Plans and CVS Health testified against the bill.

 Carter High, John Hickman, Duane Galligher, and Miguel Rodriguez testify in support of PBM reform legislation.
Carter High, John Hickman, Duane Galligher, and Miguel Rodriguez testify in support of PBM reform legislation.

 TPA Board Member and H-E-B Pharmacist Jay Bueche explains the challenges that regional pharmacy chains face with PBMs.
TPA Board Member and H-E-B Pharmacist Jay Bueche explains the challenges that regional pharmacy chains face with PBMs.


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