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Lawmakers hear competing views on PBM reform bills; co‑pay accumulator, spread pricing and transparency at center of debate
Summary
Lawmakers heard competing testimony on PBM reform bills that would ban retroactive reimbursement reductions, restrict co‑pay accumulators and require greater pricing transparency to protect independent pharmacies and patients.
Representatives Benny Cook and John Hukin jointly presented bills (including House Bill 982 and House Bill 840) intended to regulate pharmacy benefit manager (PBM) practices, increase transparency and restrict co‑pay accumulator policies.
Presenters and witnesses described multiple problems they attribute to PBM business models: spread pricing (PBMs charging purchasers more than they reimburse pharmacies), narrow specialty networks that steer patients to PBM‑owned specialty pharmacies, retroactive down‑coding of reimbursements after claims adjudication, and co‑pay accumulator programs that prevent charitable assistance and manufacturer copay support from counting toward a patient's deductible or out‑of‑pocket maximum.
Pharmacists and pharmacy groups testified that independent and rural pharmacies face severely eroded reimbursements and that closures have created pharmacy deserts in…
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