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Committee hears pharmacy reimbursement bill; debate centers on dispensing fee, PBM pass-throughs and fiscal impacts
Summary
Senate bill to require PBM pass-through and set reimbursement rules for community pharmacies drew pharmacists, insurers and PBMs into a lengthy hearing. Author voluntarily deferred the bill for a week after fiscal and implementation questions surfaced, including whether a proposed dispensing fee would raise employer premiums in some plans.
The committee took up legislation to change how pharmacies are reimbursed and to limit certain PBM practices, drawing pharmacists, insurers and plan administrators for testimony. Senator Jackson Andrews, the billauthor, described the measure as a "cleanup" to last year's law that required reimbursement at acquisition cost and said the new bill aims to reduce repetitive appeals and anticompetitive practices.
The bill includes a provision to align certain dispensing-fee payments with the Medicaid dispensing-fee ($11.81 was cited during the hearing) and would bar repetitive PBM denials that force community pharmacies to file multiple appeals to be paid their acquisition cost. Senator Jackson Andrews and…
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