Pharmacy Action Alert
The MPA Legislative Committee and Board of Directors have been working diligently to move legislation to address PBM issues that are impacting pharmacies and pharmacists across Missouri
. To that end, a comprehensive bill (
HB 1542
) was filed by Rep. Lynn Morris.
BACKGROUND
:
HB 1542 will be heard in the House Insurance Committee in the coming weeks
. The bill precludes a PBM from imposing gag clauses in their contracts with pharmacists regarding pharmacist’s communications with their patients and plan sponsors (insurance companies, TPA’s or self-insureds). In addition, it precludes a PBM from using clawbacks for any scenario, whether on copayments or DIR fees.
Note: the example that has shocked legislators is the
clawback
scenario, where a person or their employer on their behalf pays their monthly premium to the insurer, then over pays for a prescription due to the copay imposed by the PBM, of which a portion is “clawed back” and put into the PBM’s pocket. PBM’s can accomplish this same result via the DIR fees,
therefore our bill addresses all clawback scenarios that are not a result of “true” overpayments nor fraud
.
When talking to your legislator, use your own examples and experiences with this issue, BUT confine your comments to this issue only. Be sure your explanations are thorough, and do not use pharmacy lingo – layman’s terms only please. If you talk to them on multiple injustices at one time, it will be too overwhelming.
ACTION REQUESTED:
1.
Call your Member of the Missouri House (and follow up with an email) to share your stories specific to the copay clawback issue and how it has impacted patients.
2.
Discuss with your Member the impact that DIR fees are having on your pharmacy and access issues for your patients. (NOTE: this state bill will not address DIR fees in the Medicare Program since it is a Federal Program, so keep your comments focused on why DIR fees should not be permitted on the state level.
3.
Ask for their support for
HB1542
(sponsored by Rep Lynn Morris) to fix these PBM issues.
For reference, following is the language in the bill for your reference when speaking to your legislator:
“2. No pharmacy benefits manager shall charge or collect from a covered person a co-payment for a prescription or pharmacy service that exceeds the amount retained by the pharmacist or pharmacy from all payment sources for filling the prescription or providing the service.”
“3. No pharmacy benefits manager shall prohibit a pharmacist or pharmacy with which the pharmacy benefits manager has entered a contract from” interacting with the patient and plan sponsor about their pharmacy benefit.
“5. No pharmacy benefits manager shall charge or hold a pharmacist or pharmacy responsible for any fee that is related to a claim unless the amount of the fee can be determined and has been disclosed to the pharmacist or pharmacy at the time of the claim’s adjudication.”
VERY IMPORTANT, PLEASE SEND ALL FEEDBACK TO
Ron L. Fitzwater, CAE, MBA - Chief Executive Officer at:
ron@morx.com
