Nevada senators hear bill to move Medicaid to single pharmacy benefit manager; pharmacists, patient groups back measure

Vice Chair Angie Taylor opened a hearing on Senate Bill 389, which would require the Nevada Medicaid program to select a single pharmacy benefit manager (PBM) to administer pharmacy benefits for the state’s Medicaid enrollees and bar that PBM’s use of spread pricing.

Sen. Melanie Scheibel, the bill’s sponsor, told the committee SB389 would “require the state Medicaid plan to switch to a single PBM” and said the proposal complies with federal law and would still allow multiple managed care organizations to operate so long as they all use the same PBM. “It would prohibit the use of spread pricing by that pharmacy benefit manager,” Scheibel said.

Pharmacists, pharmacy trade groups and community pharmacy advocates provided the bulk of public testimony in support. Adam Porath of the Nevada Society of Health System Pharmacists described how a single PBM could reduce administrative burdens for pharmacies and create a uniform prior‑authorization process: “When patients move from fee‑for‑service Medicaid … that is then not on the formulary when they go to an MCO plan. So this would definitely streamline things for patients.”

Evan Williams of the Nevada Pharmacy Alliance cited savings reported in other states that have centralized PBM contracting, telling the committee that Ohio and Kentucky experienced large first‑year savings after similar changes were implemented: “In Ohio, the first year that they implemented this change, they had $186,000,000 of savings, and in the second year, $230,000,000. In Kentucky, they did this and they had $283,000,000 in savings.” Williams said a single PBM also protects rural and independent pharmacies from “unfair reimbursement rates.”

Several individual pharmacists from hospitals, tribal health centers and community pharmacies across Nevada also testified in support, saying a single PBM would reduce confusion at the pharmacy counter and lower costs for patients. Keibi Mejia, a policy analyst testifying for the Nevada Society for Dermatology and Dermatologic Surgery, said the bill “increases transparency and savings in Medicaid.”

Committee members asked technical questions about implementation. Scheibel and agency staff said the Department of Health and Human Services would run a competitive procurement (RFP) process to select the PBM and that the bill includes an amendment tying the contract process to federal statute to ensure compliance. Senator Titus asked who would select the single PBM and was told the department would evaluate applications under the bill’s Section 12.

The subcommittee recessed briefly to include Las Vegas testimony; callers from around the state echoed the support heard in Carson City.

The hearing closed without a committee vote; the bill will proceed to work session consideration.

Ending note: sponsors and supporters said the measure aims to reduce costs, simplify pharmacy operations and improve consistency of coverage across managed care plans. The committee did not take a final vote in the hearing and identified procurement details and federal compliance as implementation items for staff and the department to address in work session.