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Committee advances bill limiting PBM modifiers for 340B claims after debate over clearinghouses
Summary
House Bill 3409A, which restricts pharmacy benefit managers and insurers from requiring certain modifiers on 340B drug reimbursement claims when the 340B data are submitted to a clearinghouse, was advanced to the Senate floor after debate about transparency and the role of clearinghouses in handling 340B program funds.
Senator Patterson opened a work session on House Bill 3409A, which would restrict pharmacy benefit managers (PBMs) and insurers from requiring a 340B modifier on claims for covered entities under specified conditions.
Supporters said the bill reduces administrative duplication for providers and preserves 340B program protections. One committee member opposed the bill because it had not been available to stakeholders in its final form until late and because a third-party clearinghouse had become a nontransparent conduit for funds intended for patient care.
"Adding a clearinghouse is like I described before a third hand in the cookie jar of the $3.40 funds which are intended to go to individuals," said a senator opposing the bill, referencing testimony that funds routed through a clearinghouse (for example, RxParadigm) lacked transparent accounting.
Another senator said a strength of the bill is that "PBMs are not required to participate or subscribe to a clearinghouse," which she said would provide flexibility and reduce duplicate work for already-stretched providers.
The committee adopted the measure and approved moving HB 3409A to the floor with a due pass recommendation. One member indicated intent to file a minority report. The chair agreed the member would be officially noticed and signatures would be collected for a minority report.
The transcript records a roll call and that the motion passed; the committee member indicated continued concern about transparency of existing clearinghouse arrangements and sought additional contract transparency prior to implementation.
