Senate Committee Advances PBM Reform Bill Following TPA Testimony

In a rare move, the Texas Senate Health and Human Services Committee voted favorably to advance Senate Bill 2195 out of the committee on April 21, immediately following the hearing on the bill, positioning the pharmacy benefit manager (PBM) reform legislation for a vote by the full Senate that could happen as early as next week.

Texas Pharmacy Association Vice President Jay Bueche and Independent Pharmacy Academy Board Member Ben McNabb testified in support of the legislation, which prevents unfair PBM clawbacks from pharmacies, ensures patient choice, and prevents PBM self-dealing. TPA lobbyist Duane Galligher testified at the end of PBM and health plan testimony to refute their claims. Committee Chair Lois Kolkhorst powerfully laid out the bill, noting December’s unanimous U.S. Supreme Court ruling affirming states’ ability to regulate PBMs. She also highlighted the vertical integration between some insurance companies, PBMs, and pharmacies that steers patients to specific pharmacies and hinders competition. “We’re just going to squeeze out more and more pharmacies,” Kolkhorst said. “We’re going to have pharmacy deserts if we don’t allow our independent pharmacists to continue to operate.”

Bueche testified on behalf of H-E-B, explaining that pharmacy supports prohibiting post-adjudication recoupments, or clawbacks, which occur when PBMs take back money months after claims are initially paid. McNabb, testifying on behalf of TPA, shared how he went out of his way to care for a high-risk patient, but PBMs are increasingly throwing up barriers to pharmacies’ ability to care for such patients. “They impose barriers to our ability to dispense specialty medications, such as the antipsychotic medication this patient takes, by requiring expensive accreditations or certifications that are not attainable by independent pharmacies like mine, and that do not improve patient care in any way.” TPA members are encouraged to watch recordings of the testimony. Click here to view part 1 (skip ahead to 01:59:00) and click here to view part 2 (skip ahead to 0:55:00).