PA Legislature Begins Action On MCO Reform Legislative Package

June 07, 2019

Since recent Pennsylvania State Auditor General highly critical reports of Pennsylvania's Medicaid Managed care PBM run prescription program, IPC is now working with the Pennsylvania Pharmacists Association and other Pennsylvania pharmacy groups to push the following state 5 bill legislative package to reform the PA MCO prescription drug program:

  • HB 941 (Reps. Heffley & Matzie)  Fair MCO Rx Reimbursement and Transparency - provides: 1) accountability by allowing the PA HHS Department to review MCO PBM contracts and monitor payment information; and 2) requires MCO PBM reimbursement at no less than PA Medicaid reimbursement rates (NADAC + $10 fee).
  • HB 942 (Rep. Grove)  Medicaid Formulary Input Expansion - Increases the PA Medicaid P&T Committee to include 2 PA pharmacists and legislative representatives in order to hold MCO PBM accountable on formulary decisions.
  • HB 943 (Rep. Gaydos)  Gag Order Clauses Prohibitions - prohibits MCO PBM contract "gag clauses prohibiting pharmacist from: 1) disclosing pricing information to their patients  and 2) discussing PBM reimbursement and other PBM network contract provision with state elected and appointed officials.
  • HB 944 (Rep. Fritz)  MCO PBM Contract Auditing  - provides: 1) State Auditor General with the power to audit MCO PBMs claims, review their contracts and have access to DHSS past reviews of MCO contract reviews; and 2) essentially creates a fiduciary responsibility by PBMS to MCOs and PA Medicaid.
  • HB 945 (Rep. Barrar)  MCO PBMs Conflicts of Interest Prohibitions - Prevents Medicaid MCO's from contracting with PBMs that also own retail pharmacies.

This package implements the Auditor General recommendations and is geared to ending PBM abuses in Medicaid Managed Care.

To move these bills through the PA House, we need you to take the following actions:

  • The PA House Health Committee will be considering these bills on Tuesday, June 11 at 9:30 AM  To ensure this bill gets has the full support of this committee, IPC needs you TODAY and MONDAY to please contact  these Committee Members and ask them to co-sponsor and vote YES for all these bills. Tell them your stories about how the MCO contracts harm your MCO pharmacy patients and your ability to well serve them.  For talking points and a letter to email them click here.     
  • Call or email your PA State Representative and ask them to Co-Sponsor each bill in the package. For talking points and a letter to email them, click here.  

If you are in the District of any of these bill sponsors, thank them for supporting these pro-patient and pro-pharmacy MCO PBM reform bills.

IPC is committed to working in Pennsylvania with our industry partners to reform the MCO Prescription program, but your grassroots involvement is critical to this effort.  Act now to contact your PA State House member!