Senate committee takes up PBM reforms aimed at directing rebates to patients and protecting independent pharmacies

The Senate Commerce and Labor Committee heard Senate Bill 316, a broad package of provisions aimed at pharmacy benefit managers (PBMs), their relationships with insurers and pharmacies, and the flow of manufacturer rebates. Sponsor Sen. Rochelle Winn (D‑Clark) described the bill as a patient‑first reform that would require reporting by insurers and PBMs, strengthen a PBM duty of care to patients, prohibit discriminatory or steering practices that favor PBM‑affiliated pharmacies and require that rebate savings be passed on to patients.

“Senate Bill 3 16 will require that 100% of the rebate minus agreed upon fees and other required reimbursements go to the benefit of the patient either at the point of sale at the pharmacy counter or through lowering their out of pocket cost sharing obligations with their health insurer,” Sen. Rochelle Winn said, outlining one of the bill’s central provisions.

Caitlin Cardavani of New Day Nevada told the committee the bill would require health plans and PBMs to report certain rebate and contract information to the Division of Insurance and would add statutory protections to prevent PBMs from steering patients to affiliated pharmacies or imposing restrictions that make it difficult to use unaffiliated pharmacies.

Supporters included pharmacists’ associations, physician groups, patient advocates and community pharmacy representatives. Testimony from the Nevada State Medical Association said PBM practices such as restrictive formularies, step therapy and prior authorization can delay access to needed medicines. Independent and health‑system pharmacists urged the committee to protect patient choice and to address routine “clawbacks,” where PBMs later recoup payments.

Opponents included PBM trade association PCMA and some employers and government entities that administer self‑insured plans. Bill Lehi of PCMA said PBMs exert downward pressure on prices and cautioned that transparency requirements should apply across the supply chain — manufacturers, wholesalers, pharmacies, health plans and PBMs — rather than singling out PBMs. Several public‑employer and self‑insured plan representatives told the committee they already use rebates to lower plan costs and warned that some changes could increase costs for employers and members; the city of Henderson filed a fiscal note describing potential negative financial impact to its self‑insured plan.

Agency staff flagged implementation issues and a fiscal note for the Division of Insurance. Adam Plaien of the Division said the agency had not previously administered the proposed regulatory responsibilities and that a confidentiality and administrative process for complaints and reports would need attention; he said some definitions (for example, “timely”) would likely require rulemaking.

Senators asked detailed questions about the bill’s scope, including which drugs would be in the initial reporting lists (transcript references to 25 versus 50 high‑cost drugs), confidentiality of reporting and whether federal reporting obligations for some employers already address part of the sponsor’s aims. Sponsor Winn said she was working with stakeholder groups and was open to amendments to address those concerns.

No committee vote was taken on SB 316 at the hearing. Supporters and opponents indicated they would continue negotiating changes ahead of any work‑session action.