September 2024 Pharmacy Policy

New Pennsylvania Law Increases PBM Transparency, Accountability

In July, Pennsylvania Gov Josh Shapiro signed into law bipartisan reforms in the 2024-2025 state budget designed to increase oversight of pharmacy benefit managers (PBMs). Additionally, Shapiro signed House Bill (HB) 1993 into law, which increases regulatory oversight of PBMs and provides strong protections for patients with commercial insurance.

Image credit: MP Studio | stock.adobe.com

HB 1993 is part of bipartisan efforts to ensure ongoing access to local, independent pharmacies and grants the Pennsylvania Insurance Department the authority to regulate PBMs. According to data from the Center for Rural Pennsylvania, an estimated 540,000 rural residents of the state lived in a pharmacy desert at least 5 miles from the nearest pharmacy in 2022. Furthermore, over 140 pharmacies have closed in the state since January 2024, exacerbating the challenges.

HB 1993 prevents some patient steering practices common with PBMs, such as requiring a policyholder to purchase medications exclusively through a mailorder pharmacy or at a pharmacy owned or controlled by the PBM. Additionally, the law bans clawbacks that lead to higher out-of-pocket expenses for patients at the pharmacy counter.

Notably, the law also prohibits PBMs from unilaterally changing the terms of a contract with a pharmacy or pharmacy services administrative organization. Before this bill, PBMs could alter contract terms without input from pharmacies, creating significant challenges for smaller, independent pharmacies. PBMs in the state must now confer and get agreement from pharmacies before changing terms of a contract. —Aislinn Antrim, Assistant Managing Editor

REFERENCE

Governor Shapiro, Pennsylvania insurance commissioner, legislative leaders host ceremonial bill signing of new law that increases transparency and accountability of pharmacy benefit managers, cuts costs, and supports local pharmacies. News release. Commonwealth of Pennsylvania. July 26, 2024. Accessed August 19, 2024. https://www.pa.gov/en/governor/newsroom/2024-press-releases/governor-shapiro--pennsylvania-insurance-commissioner--legislati.html

NASPA Releases 2024 Provider Status Midyear Legislative Update

The National Alliance of State Pharmacy Associations has released its midyear report with updates on legislative efforts toward pharmacist provider status, highlighting that 147 bills related to pharmacist scope of practice and payment for pharmacist-provided services have been introduced across 38 states so far in 2024.

According to the report, the bills focus on various issues, including immunization authority, test-to-treat services, and the prescription of preexposure prophylaxis medications. As of August 2024, 45 bills in 27 states had been signed into law.

“While these legislative victories represent significant progress in expanding pharmacist scope of practice and securing payment for pharmacist-provided services, it’s important to recognize that this is only a fraction of the legislative work undertaken by state pharmacy associations,” the report said. “Beyond payment and scope, state pharmacy associations engage in a wide range of advocacy efforts to advance the profession and improve patient care.” —Aislinn Antrim, Assistant Managing Editor

REFERENCE

2024 provider state midyear legislative update. National Alliance of State Pharmacy Associations. August 9, 2024. Accessed August 19, 2024. https://naspa.us/blog/resource/2024-provider-status-midyear-legislative-update/

CMS Announces Negotiated Prices for 10 Drugs Under Inflation Reduction Act

The Centers for Medicare & Medicaid Services (CMS) has announced the negotiated lower prices for the 10 drugs that were initially selected for price negotiation under the Inflation Reduction Act (IRA), with the new prices expected to go into effect for patients with Medicare Part D beginning January 1, 2026. The drugs cover disease states including diabetes, heart failure, rheumatoid arthritis, chronic kidney disease, psoriasis, psoriatic arthritis, cardiovascular disease, and blood cancers.¹

In August 2023, CMS announced the first 10 prescription drugs chosen for price negotiation. According to CMS, the selected drugs accounted for approximately 20% (nearly $50.5 billion) of the total cost of drugs in Part D from June 1, 2022, to May 31, 2023. In August 2022, President Joseph R. Biden signed the IRA into law, which advanced Medicare with growing benefits, lower drug costs, and improved viability of the program.²

The percentage discounts for the negotiated prices are as follows³:

• Apixaban (Eliquis; Bristol Myers Squibb): 56%
• Empagliflozin (Jardiance; Boehringer Ingelheim): 66%
• Rivaroxaban (Xarelto; Janssen): 62%
• Sitagliptin (Januvia; Merck Sharp Dohme): 79%
• Dapagliflozin (Farxiga; AstraZeneca): 68%
• Sacubitril/valsartan (Entresto; Novartis): 53%
• Etanercept (Enbrel; Immunex Corp): 67%
• Ibrutinib (Imbruvica; Pharmacyclics): 38%
• Ustekinumab (Stelara; Janssen Biotech): 66%
• Insulin aspart (including Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill; Novo Nordisk): 76%

CMS is expected to select 15 more drugs to be covered under Part D, with negotiations planned for 2027, and 15 additional medications for 2028. There will be 20 more drugs selected for each subsequent year.² —Ashley Gallagher, Associate Editor

REFERENCES

1. Negotiating for lower drug prices works, saves billions. News release. CMS. August 15, 2024. Accessed August 15, 2024. https://www.cms.gov/newsroom/press-releases/negotiating-lower-drug-prices-works-saves-billions

2. Ferruggia K. CMS announces first 10 drugs to undergo price negotiations under Inflation Reduction Act. Pharmacy Times. August 30, 2023. Accessed August 15, 2024. https://www.pharmacytimes.com/view/cms-announces-first-10-drugs-to-undergo-price-negotiations-under-inflation-reduction-act

3. Medicare drug price negotiation program: negotiated prices for initial price applicability year 2026. CMS. August 15, 2024. Accessed August 15, 2024. https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026