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Pharmacists and independent pharmacies urge reforms: PBM transparency and provider recognition
Summary
Pharmacists, independent pharmacy representatives and pharmacy organizations urged the committee to advance bills to require fair MassHealth‑aligned reimbursements to pharmacies and to recognize pharmacists as reimbursable health‑care providers able to screen, test and treat limited conditions.
Pharmacists, pharmacy associations and independent pharmacy advocates told the Joint Committee on Financial Services that both pharmacy benefit manager (PBM) practices and the narrow reimbursement model for pharmacy services have harmed local pharmacies and reduced patient access.
David Morgan, a pharmacist with nearly five decades of practice, testified in support of House 13,26, a bill that would require PBM and managed‑care organizations to reimburse retail pharmacies at rates aligned with the MassHealth pharmacy provider manual. Morgan said PBM consolidation has created market power that drives down community‑pharmacy margins and contributes to closures: ‘‘They control an oligopoly ... they promote out‑of‑state mail order and specialty pharmacies, sending millions of dollars out of Massachusetts,’’ he said.
Pharmacy advocates asked the committee to consider two linked reforms: (1) greater transparency and parity in PBM reimbursement to protect local access, and (2) statutory recognition of pharmacists as reimbursable health‑care providers. The latter was presented in testimony supporting House 10,91 / Senate 800 to enable pharmacists to screen, test and treat DPH‑designated conditions (for example, strep, influenza and COVID‑19) and to be paid when insurers reimburse a comparable service performed by a physician or advanced practice clinician.
Pharmacists argued the COVID‑19 emergency orders demonstrated the profession’s capacity to safely expand access — they cited thousands of tests and vaccinations delivered during the pandemic — and that sustainable reimbursement is needed to continue such services. Hospital and community pharmacy leaders said broader provider recognition would reduce pressure on emergency departments and primary‑care offices, improve immunization access and enable pharmacists to manage complex therapies in collaboration with clinicians.
Witnesses asked the committee to report bills favorably and to work with insurers on reimbursement language. There were no votes taken at the hearing.
