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Laura Hoch, associate vice president for advocacy at the National Multiple Sclerosis Society, urged the committee to curb PBM incentives that favor higher list prices. Hoch cited Federal Trade Commission reports that, she said, show PBMs may profit from arrangements that favor certain brands and can raise patient costs at the pharmacy counter: “PBMs may prefer a higher cost brand drug because it will increase their revenue,” she said.

Pharmaceutical industry representatives told the committee the bill’s core reform — removing compensation tied to drug list prices and replacing it with flat fees — is a useful corrective. “To the extent that PBMs provide valuable services … they should be entitled to compensation based on that value. But PBM compensation should not be tied to the price of medicine,” said a witness from PhRMA, citing concerns that rebate structures can distort formulary choices.

PBMs and their trade association, however, opposed several bill provisions. Sam Hollomire of the Pharmaceutical Care Management Association told the committee that banning performance‑based compensation and spread pricing would likely result in reduced manufacturer rebates and higher premiums. He cited a New Mexico fiscal estimate as an example and warned the state employee plan could see large premium increases if rebates fall away.

PBM opponents also challenged proposed fiduciary duties. PCMA’s witness said PBMs do not control plan assets and that making them fiduciaries could increase legal liability and costs for plans, translating into higher premiums. PBM testimony included a claim that Connecticut PBMs pass back about 99.7% of negotiated rebates to plans, citing a Connecticut Insurance Department figure.

Public interest and patient advocacy witnesses countered that vertical integration and opaque rebate flows have real costs for patients and independent pharmacies. Dawn Holcomb of the Connecticut Oncology Association told the committee the bill is “a drop in the bucket” but an important start to restoring patients’ choice of pharmacy and ensuring clinicians can rely on medically appropriate formulary decisions.

Some legislators pressed for more data and contracts to evaluate the projected fiscal effects. Representative Pavlak Damato asked PBM witnesses for sample contracts and more transparency about compensation calculations. PBM representatives said they would provide examples for further review.

The committee heard a range of fiscal projections and policy tradeoffs: supporters argued that delinking compensation from list price would reduce incentives to prefer higher‑cost products; PBMs warned that removing rebates or spread pricing could reduce negotiated discounts and increase employer and state plan costs. Several witnesses said enhanced rebate reporting and transparency would help policy makers assess net effects.

Committee members indicated they will continue to weigh the tradeoffs, request additional data from PBMs and other parties, and consider narrowing or amending statutory language to address fiscal and implementation concerns.","mediaType","Video","parentTitle","2/27 Insurance and Real Estate Public Hearing","oneSentenceSummary","Drug makers, patient advocates and PBM trade groups debated Senate Bill 1366. Advocates sought delinking PBM compensation from list price, spread‑pricing bans and rebate transparency; PBMs warned of higher premiums and unintended consequences.","taxTitle","Insurance and Real Estate, House of Representatives, Committees, Legislative, Connecticut","taxId",15589,"location","Connecticut","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6659389,"Pharmacists, students and associations urge Connecticut to move from study to implementation on reimbursement",10177,119000,10296000,"/Search/View?dp=1&key=2471608-5412f656599a5900482e20933b77a4a0&start=119&end=10296","https://assets.pipeline.soar.com/2471608-5412f656599a5900482e20933b77a4a0/thumbnail_119000.jpg","/articles/6659389/Connecticut/Pharmacists-students-and-associations-urge-Connecticut-to-move-from-study-to-implementation-on-reimbursement","https://secure.pipeline.soar.com/6659389-b4e5c3675f4d75a918b2b81373bf0a4d/orig.mp4?Expires=1772859011&Signature=l7e3zR2lZ-rW~9i63L3cBRs1icPPD4Cop4GLrU6d84YhDl-tjiTsHbJvH1mVPQ-xyeKcp4kbfrvyByFyn57mF20dpD2wRy2mduoUR9lBqnULJP3Y~9E84lsocdLec5mLlB5V5SYXbCVaHzSSJyLWofa9beLuPaPiDGVkVTGHXfbCgLU4vP7RinKrp1aNC9c4ynHk-2aofJiSX0p86cuJ~RoWJ5U87Q6QEQqZyjnwH5Ki6faQbdwoBxSp~MBM0j1B2O5uiYMYNv82~AmvHJKxpu3hTVD4ZMGRdeP-Mf2eMIomqIHJsvAVLFA97rtqRzOlZAVp1N~A~RxmAuUNw~I30Q__&Key-Pair-Id=KUT5TJCACFTXG","Pharmacists, pharmacy students and trade groups told the Joint Insurance and Real Estate Committee on Feb. 26 that Connecticut should adopt concrete reimbursement policies for clinical services provided by pharmacists rather than delay implementation with a long study.

Nathan Tinker, chief executive officer of the Connecticut Pharmacists Association, told the committee Connecticut is one of only a handful of jurisdictions that has not established reimbursement for pharmacist-provided clinical services and urged lawmakers to move quickly. “Without reimbursement, pharmacies struggle to sustain these services and patients face unnecessary barriers to care,” Tinker said.

The push came from a range of witnesses, including independent pharmacists and students from the University of Connecticut School of Pharmacy. Several witnesses described existing state policy that authorizes pharmacists to deliver services — such as prescribing hormonal and emergency contraception, providing HIV testing and treatment, and administering vaccines — but does not provide a reimbursement pathway through Medicaid or commercial payers.

A group of UConn pharmacy students told the committee that lack of payment undermines retention: “I would like to practice in Connecticut, but why should I stay when my education, expertise and clinical services in many states have payment parity with other clinicians?” said Armand Fabrizi, identified as a second-year PharmD candidate at UConn.

Industry representatives urged the committee to adopt a working group that would include payers, regulators and provider representatives to draft implementation steps. Balawa Akwacoku, associate director of the National Community Pharmacists Association, pointed to Maryland’s process in which a state-sponsored working group led to adoption of pharmacist reimbursement rules and said Connecticut could follow that model.

Proponents offered quantitative context. Tinker cited a report estimating Connecticut will need about 5,700 more health care providers by 2028 and said reimbursing pharmacists could help narrow that gap. Nate Rickles, a board‑certified psychiatric pharmacist and associate dean at UConn, said school data show a majority of soon‑to‑graduate pharmacy students view lack of clinical reimbursement as a factor in their decision whether to remain in the state.

Speakers from the community pharmacy sector said payment parity would let pharmacies expand timely access: pharmacist Gus Campos said contractual changes at PBMs had already limited patients’ choice of pharmacy and noted that payment makes offering extra services financially feasible. Pharmacists and student witnesses said other states — including North Carolina, Colorado and Hawaii — already reimburse pharmacists for some clinical services.

Committee members asked detailed questions about implementation mechanics and whether paper studies are necessary; some lawmakers signaled support for substituting a working group for a full yearlong statutory study if stakeholders agreed on the group’s scope. Representative Wood said she was “happy to support the working group model” if that is a better path to concrete policies.

If lawmakers opt for the study route, witnesses requested that study language require clear deliverables and stakeholder representation so findings lead quickly to implementation steps.

Connecticut’s pharmacy organizations and schools offered to collaborate with state agencies and payers on drafting workable reimbursement models that use standard medical billing codes and align Medicaid and commercial payment where possible. They emphasized that reimbursement would not only sustain existing services, but could create new points of access for contraception, HIV prevention and vaccinations across the state.

Without legislative action, witnesses warned, pharmacists will be unable to sustain expanded clinical services and pharmacy closures could worsen “pharmacy deserts,” reducing access to frontline care.

Looking ahead, proponents asked the committee to convene a working group that includes the insurance commissioner, the commissioner of consumer protection, payers, pharmacists and legislators to produce a short implementation roadmap by next session.

Two transcript excerpts supporting this article: Nathan Tinker: “Without reimbursement, pharmacies struggle to sustain these services and patients face unnecessary barriers to care.” UConn student Armand Fabrizi: “I would like to practice in Connecticut, but why should I stay when my education, expertise and clinical services in many states have payment parity with other clinicians?”","Pharmacists, students and pharmacy associations urged the Insurance and Real Estate Committee to adopt implementation steps or a working group for reimbursing pharmacist-provided clinical services rather than a yearlong study, citing workforce retention and expanded access to care.","actionData","errors"]

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Pharma, patient groups and PBMs clash as Connecticut committee considers PBM reforms

Pharmacists, students and associations urge Connecticut to move from study to implementation on reimbursement