New regulations reining in pharmacy benefit managers (PBMs), the powerful middlemen between pharmacies and insurance companies, reached Gov. Shapiro’s desk last week. The bill is a massive bipartisan win that will give pharmacies much-needed freedom — but the legislation stops short of enacting what pharmacies truly needed: reimbursement rate floors.
The need for PBM reform has become acute. PBMs, which once served only to process prescriptions, now handle the relationships among drug manufacturers, insurance companies, pharmacies and patients, setting the terms and pricing for nearly everything. Their power is immense because they gatekeep access to major insurers and drug manufacturers in their exclusive networks. This means pharmacies often sign on to unfair pricing structures to keep access to patients.
HB1993, sponsored by Allegheny County’s Rep. Jessica Benham, D, immediately shuts down this unfair tactic. PBMs can no longer shut out or overcharge pharmacies that don’t have contracts with them — a major reason that they were able to impose their highly restrictive conditions on pharmacies in the first place.
