IPC Advocacy in Action

Department of Medicaid: IPC joined forces with the Ohio Pharmacists Association (OPA) and other Ohio pharmacy groups to influence the final Ohio 2024-2025 state budget, resulting in a 5.7% increase in the Ohio Medicaid managed care single PBM professional dispensing fee.

MEDI-Cal: Successful start of Medicaid Carve out to FFS (NADAC & $10.05) ($380 Million net savings with full payment to pharmacy)

State Budget bill Elimination of Medicaid FFS independent pharmacy claw back of ingredient cost payments (saved small pharmacies $144 million)

S 7506 (State Appropriations Act): enactment of Medicaid managed care Rx program carve out to Medicaid Fee for Service payment (NADAC and cost to dispense fee)

Governor’s Executive Order (22-164) requiring cost-based reimbursement pass through transparency for FL Medicaid managed care and FL State Public Employee Health Benefits Rx programs

HB 4430: Authorizes pharmacists providing HIV PrEP/PEP patient care

Public Comments Input for Development of Implementing Regulations for New York State PBM Licensure and Regulation Law

HB 42: Enacted full pharmacist provider billing status law

Implemented Medicaid managed care single PBM contract to implement cost-based pass-through reimbursement (AAC drug reimbursement & 3 tier COD fees). Increases OH independent pharmacy fees reimbursement by 995%.

HB 4034: Enacted disease specific Pharmacist provider billing status law

HB 21-1275: Requires Colorado’s Medicaid program to pay pharmacists when working in a collaborative practice agreement with a physician and allows clinical services to be reimbursed at federally qualified health centers

Department of Medicaid: Implements Medicaid Managed Care Rx program cost-based transparent (NADAC and COD PDF) pharmacy reimbursement mandate

SB 395: State licensure requirement for PBMs; prohibits PBMs from using deceptive advertising; requires PBMs to offer adequate provider networks

Department of Medicaid: Implements Medicaid Managed Care Rx program cost-based transparent (NADAC and COD PDF) independent pharmacy reimbursement mandate

HB 1492: Prohibits PBMs from holding pharmacies responsible for prescription claims processing/transaction fees

S3762: Creates state licensure of PBMs and regulation of PBM economic contract provisions (including ERISA plans)

S3566: Expansion of Anti-Mandatory Rx Mail Order law

HB 110: Medicaid managed care Rx enhanced dispensing fee continues for two additional years

HB 1763: Prohibits PBMs from retroactively reducing claim amounts through effective rates, quality assurance programs, or other means; prohibits a PBM from reimbursing its affiliated pharmacies at higher rates than non-affiliated pharmacies; protects a pharmacy’s right to offer home-delivery services; prohibits a PBM from requiring accreditation requirements that are more stringent than those required by the state or federal government; protects a pharmacy from PBM retaliation for exercising its rights under the bill

HB 1919: Prohibits a PBM/insurer or its affiliate from transferring patient data for a commercial purpose; prohibits a PBM/ insurer from steering patients to, or requiring a patient to use, an affiliated pharmacy

SB 3: Licensure and regulation of PBM practices (prohibits gag clauses, fair audit procedures, requires notice of pharmacy accreditation)

SB 255: Requires the state Medicaid program to provide Medicaid reimbursement for medical services provided by licensed pharmacists

AB 1710: Allows pharmacists to administer all FDA Approved Vaccines

S 7506: (State Appropriations Act) Enactment of Medicaid managed care Rx program carve out to Medicaid Fee for Service payment (NADAC and cost to dispense fee)

HB 5396: (State Appropriations Act) Mandate for transparent cost-based pharmacy reimbursement for Medicaid Managed Care prescription claims; protections against MCO: claim payment claw back; prior authorizations; fee increases

Ohio Medicaid Department (OMD) Actions: Award of Medicaid single PBM contract with transparent pass-through payments mandate- Implementation of Appropriations Act Pharmacy lifeline additional dispensing fee ($3/script)- Final regulations for Medicaid Pharmacists Medical Services Provider billing status

HB 941: Authorize state study of Medicaid Managed Care Rx Program spread pricing. Authorizes PA Medicaid audit of PA MCO & requires PA Medicaid review of MCO Rx payment methodology, Prohibits MCO Rx: claims payment clawbacks; patient steering; MCO spread pricing; undisclosed P-O-S transmission fees