Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pharmacy Benefit Management topic
No spam. Unsubscribe anytime.
Senate committee reviews SB 149 to centralize Medicaid pharmacy benefit management; sponsors and pharmacy groups make case for single state PBM
Summary
Senate Bill 149 would require Nevada to contract with a single state‑selected pharmacy benefit manager for Medicaid programs and impose enhanced reporting, fiduciary duties and prohibitions on spread pricing. Supporters cited savings seen in Ohio and Kentucky; some pharmacy stakeholders asked for amended reimbursements to avoid unintended costs.
Senate Bill 149, sponsored by Senator Jeff Stone, would require Nevada’s Medicaid program to use a single state‑contracted pharmacy benefit manager (PBM) for the administration of pharmacy benefits across fee‑for‑service and managed‑care lines, impose fiduciary duties on that PBM, forbid spread pricing and give the Department of Health and Human Services (DHHS) authority to approve pharmacy contracts and reimbursement methodologies.
Senator Stone called the bill a response to concerns about PBMs’ market power and opacity. He said third‑party PBMs ‘‘serve as the middlemen’’ that control formularies, reimbursements, patient cost sharing and data sharing and that recent federal reporting and state audits have found PBMs retain revenue that does not flow back to payers or pharmacies.
Ken Kunke, executive director of the Nevada Pharmacy Alliance and a practicing pharmacist, described the functional changes SB 149 would make: require DHHS to set eligibility criteria for a state PBM, require the state PBM to use a single preferred drug list for Medicaid plans, adopt dispensing fees and anti‑discrimination rules to prevent steering toward PBM‑owned pharmacies, require the state PBM to transmit claim-level data to DHHS within 48 hours, and prohibit spread pricing and post‑sale clawbacks to pharmacies. Kunke cited Ohio and Kentucky experience, which he said produced multi‑million‑dollar savings after state PBM changes.
Senator Stone introduced testimony by national and out‑of‑state experts: Ben Mudd (pharmacy association executive in Kentucky) described Kentucky’s experience with a single‑PBM model and reported multi‑year savings; Trevor Douglas (Oregon Health Authority/ArrayRx) described Oregon’s public purchasing arrangements and estimated hundreds of millions in pass‑through savings across participating programs. Keiko Duncan, pharmacy director at DHHS, remained at the table to answer NV Medicaid implementation questions and to discuss a department amendment aimed at reducing fiscal impacts.
Multiple Nevada pharmacy and community pharmacy organizations testified in support. Witnesses emphasized independent pharmacies’ financial pressure from PBM rules and said a state PBM model can increase transparency, reduce spread pricing and ensure a greater share of manufacturer rebates benefit taxpayers and patients. The Nevada Society of Health System Pharmacists supported the bill while urging acceptance of the Medicaid Department’s amendment to avoid higher payments to some providers. Several witnesses submitted written evidence describing audits and enforcement actions against PBMs in other states.
Committee members asked about spread pricing, whether the model can be made to include other state purchasing (e.g., corrections), and how rebates and passthrough mechanisms would be handled. State and out‑of‑state presenters described pass‑through contracting and fiduciary approaches used elsewhere; witnesses noted implementation details matter and that contracts, oversight and dispensing fees are central to success.
No committee vote was recorded in the hearing. Supporters urged the committee to adopt the Medicaid amendment to address fiscal concerns and move the bill forward.
