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Committee hears bill to let pharmacies refuse prescriptions reimbursed below acquisition cost
Summary
Senate Bill 247 would let pharmacies decline to dispense prescriptions when reimbursement is below acquisition cost and require PSAOs to share PBM contract details; pharmacists told the committee low reimbursements are forcing them to stop stocking brand-name drugs and cited examples of significant losses.
Senate Bill 247 would prohibit pharmacy-network exclusions for pharmacies that refuse to dispense a prescription when the reimbursement from a pharmacy benefit manager (PBM) or related contract is below the pharmacy's acquisition cost, and would require greater transparency from pharmacy services administration organizations (PSAOs).
"What this bill will do is it will provide some protections for pharmacies when reimbursements for drugs are below cost," sponsor Sen. David Rochefort said, telling the committee the measure is intended to stop pharmacies from being forced to fill prescriptions at a loss or risk network exclusion.
Glenn Perrault, a pharmacist and owner of Colonial Pharmacy in New London, told the committee his store lost more than $6,000 in underpayments on brand-name drugs over a two-month period and said he has stopped stocking some brand-name medications as a result. Perrault described PBM contracting practices, multiple MAC (maximum allowable cost) lists and limited ability for pharmacies to negotiate as contributing factors.
"My approach right now is that I will run the claim for the patient. If I get paid appropriately, I'll order the drug in for the patient. If I do not get paid appropriately, I will reach out to the PBM," Perrault said. "There is a take it or leave it from the PBM. If you don't want it, we will steer patients to a different pharmacy that will take it."
The bill would also require PSAO contracts with pharmacies to include a provision providing pharmacies a copy of any contract the PSAO signs with a PBM and related amendments and payment schedules, within three calendar days after execution. Sponsors said that transparency requirement is designed to help independent pharmacies understand the terms negotiated on their behalf.
The Insurance Department and Medicaid counsel told the committee they are drafting technical amendments to place oversight and consumer-protection enforcement in the appropriate statutory sections and to avoid conflict with federal Medicaid rules. Committee members and witnesses discussed placing PSAO oversight under consumer protection and clarifying the statutory section where the provisions belong.
The committee closed the hearing and will consider technical amendments in a future meeting. No committee vote was recorded during the hearing.
