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Lawmakers hear competing views on PBM regulation as pharmacists warn of closures and industry warns of legal conflicts
Summary
During a hearing on House Bills 47-94 and 47-91, independent pharmacists warned mandated reimbursement floors could force rural pharmacies to close, while PBM and insurer representatives cautioned that parts of the bills could conflict with federal law and disrupt employer-sponsored plans; committee members encouraged continued negotiation and staff-led study.
The Regulatory Review Committee heard more than an hour of testimony for and against two House bills aimed at pharmacy benefit managers and reimbursement rules.
Representative Sessions, sponsor of the bills, said his interest in the subject began after problems his family faced getting a seizure medication refilled and called for oversight of PBM practices that he said limit patient access and choice.
Trey Walker, executive director of the South Carolina Alliance of Health Plans, opposed parts of the legislation. Walker said insurers contract with PBMs to administer complicated prescription-benefit arrangements and that spread pricing or administrative-fee models provide predictability for employers. He warned that a legislative mandate forcing business-model changes could have unintended negative effects on employers, insurers and consumers.
Independent pharmacists gave testimony supporting reform. John Pew, owner of Prosperity Drug, said his rural pharmacy is losing money on an estimated 25% of prescriptions because negotiated reimbursements do not cover acquisition and dispensing costs. "All we're asking for is there's plenty of money being spent on prescription drugs, but it's not getting to the provider," Pew said, and urged a statutory floor or dispensing margin to keep local pharmacies open for rural patients.
Industry witnesses representing PBMs and national trade groups opposed the bills as written. Michael Power of the Pharmaceutical Care Management Association said one section of the proposal would create prohibitions and anti-steering language that could conflict with recent court rulings, and that some rebate-pass-through language would conflict with federal law requiring certain rebate handling. He cautioned lawmakers about state provisions that could be preempted or create legal exposure.
Committee members used the hearing to press for more facts and suggested staff convene stakeholders to seek common ground. The chair urged participants to work with committee staff to craft solutions; no committee votes were taken on the PBM bills during the session.
