Medicaid Reform Bill Dies in Closing Days of Session

One of pharmacy’s top legislative priorities failed on Sunday, just before the close of the 86th legislative session. HB 3388 would have required PBMs in Medicaid managed care to establish a reimbursement floor for pharmacies, which would have paid pharmacies the Medicaid fee-for-service rate of the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee.

Although the bill easily passed both the full House and Senate Health and Human Services Committee, a late floor amendment was added before it passed the Senate. The amendment supposedly addressed an $8 million fiscal note on the bill and would have allowed the Executive Commissioner of the Health and Human Services Commission to set the dispensing fee based on cost neutrality to the state. There was also language in the amendment that could be viewed as narrowing networks and skirting the any-willing-pharmacy law in Texas Medicaid under the guise of value-based contracting, as well as what could be construed as allowing DIR-type language in Medicaid managed care.

Due to there being a difference between the bill that passed the Senate and the bill that passed the House, a conference committee was appointed to work out an agreement. Pharmacy worked diligently with legislators on a compromise to the amendment, but a clerical error by a legislative office negated the conference committee agreement.

Pharmacy’s dilemma was to accept the troubling amendment or stick with current law. Although pharmacy would have liked to have seen reimbursement based on acquisition cost and true economics for the dispensing fee, pharmacy decided status quo was better than the risky Senate amendment. Therefore, the bill was not brought to a final vote and died on the House floor.

Thank you to Rep. Sheffield and Sen. Kolkhorst for championing this legislation and for their tremendous efforts on this important issue.