Dec. 21, 2022

RISING TO THE CHALLENGE

Commitment, History of Wins Drive APRx Advocacy Efforts

  Download Our Full 2023 Legislative Preview


This newsletter content is excerpted from our 2023 Legislative Preview. To read the full document, which includes additional information and resources, use the link above to download it.


American Pharmacies is fiercely committed to legislative advocacy and has passed the most bills of any purchasing group in the nation. In the last year, APRX-driven legislation was signed into law in Arizona, Michigan and New Mexico, building on a long record of success that started in Texas.


“Advocacy is in our blood,” APRx President Laird Leavoy said. “It has been every bit as important as purchasing economics in our value proposition since day one. To be totally committed to the economic welfare of our members, we have to put forth maximum effort in the legislative arena.” 


Michael Wright, VP of government affairs, has spearheaded our expansion into multiple states with our trademark blend of hard work, decisive action, realistic incremental goals and key strategic partnerships. “We take a calculated, strategic approach to every state we engage in,” Wright said. “We build sustainable efforts with strong partners. That approach has helped us pass 9 of 11 bills filed in Texas and now seven bills in three other states.”


The latest was HB 4348, a sweeping Michigan PBM reform bill that prohibits clawbacks and transaction fees, protects patients' right to choose their pharmacy, bars retroactive reductions in reimbursements, requires MAC pricing transparency and creates major audit protections.


Prior to American Pharmacies' engagement, there had never been a meaningful PBM reform bill in Michigan. We got involved in 2020, hiring a lobbyist and meeting with key independents, bill sponsor Rep. Julie Calley and House Speaker Jason Wentworth. Gen. Counsel Miguel Rodriguez provided significant input on bill content. Wright and Rodriguez met several times with House and Senate leaders to build support.


Our 2021 legislative session in Texas –– spearheaded by our Texas Pharmacy Business Council –– was one for the ages, as we passed both a major PBM reform bill and an anti-steering bill, adding to our strong legacy of success there, which includes audit and MAC reforms, a clawback ban and the nation's first ban on transaction fees.


Our reputation and achievements are hard-earned and have validated our way of doing things. We rely on a well-crafted strategic plan, strong legislative allies and the finest contract lobbyists we can find. We set reasonable, obtainable goals that drive well-crafted bills, and we adhere to a strict code of ethics. It’s a game plan that has worked very well for us over the past decade and is the very core of our success. 

Budgets, Elections & Courts Shape 2023 Outlook


Most States Flush Entering 2023

State budgets are generally in a far better position entering 2023 compared to 2022, following strong revenue performance in fiscal 2022 and a sound rebound from the disruptions of the coronavirus pandemic. Revenue recovery was driven by improved economic conditions, sales tax growth and stronger employment. But slower growth, rising inflation and a possible recession pose risks going forward, so many states will prepare for a potential downturn.


In Texas, lawmakers have an estimated $27 billion surplus for the next biennium, which Republican leaders are eying for property tax relief or infrastructure improvements. Things are not so rosy in California, where legislators must deal with a projected shortfall of $24 billion, which could eat up its estimated $23 billion in reserves. Elsewhere, Minnesota has a $17.6 billion surplus, Florida is up $21.8 billion and Tennessee is about $1 billion in the black. Michigan is sitting on a surplus of $6 billion, while New Mexico has a $2.5 billion windfall. 


In many states, there will never be a better opportunity to improve pharmacy reimbursement in managed care.


Elections Bring Big Changes in Key States

The 2022 midterm elections did not produce the predicted widespread Republican victories in the U.S. House and Senate, but they did deliver some big surprises at the state level. Democrats ended almost 40 years of Republican control of the Michigan Legislature by grabbing a 56-54 majority in the House and a 20-18 advantage in the Senate. Those tight margins will necessitate a lot of compromise. Republican House Speaker Jason Wentworth, a major architect of key American-Pharmacies backed PBM reforms passed in March, will be replaced by Rep. Joe Tate of Detroit, who will become the state's first black House speaker. Key allies and supporters of the legislation remain in both chambers.


In Minnesota, Democrats narrowly won the Senate from Republicans to take full control of the statehouse. In Pennsylvania, Democrats won a surprise narrow margin in the House, but the GOP still controls the Senate. In governorships, Democrats narrowed Republicans' nationwide advantage from 28-22 to 26-24. The tight margins in Michigan, Minnesota and a few other statehouses will necessitate a bipartisan approach to passing pro-pharmacy bills in those states.

APRx Voice Grows in Court Challenges to PBM Laws


Fighting for independent pharmacies is not limited to just legislatures and Congress, and American Pharmacies joins other state and national organizations in federal court to support those defending state reforms from PBM challenges.


On Oct. 18, APRx joined four other pharmacy organizations in filing a joint amicus curiae (friend of the court) brief defending states’ rights to pass and enforce laws protecting patients and community pharmacies from predatory PBM practices. The amicus brief was filed in the 10th Circuit Court of Appeals in cooperation with the American Pharmacists Association, the National Association of Chain Drug Stores, the National Community Pharmacists Association and the Oklahoma Pharmacists Association. 


In 2019, the Oklahoma Legislature passed the Patient’s Right to Pharmacy Choice Act to protect access to pharmacies and protect pharmacies from self-

serving practices of PBMs. The new law was soon challenged in court by the

Pharmaceutical Care Management Association (PCMA, the PBMs’ trade lobby). 


In early April, the U.S. District Court for the Western District of Oklahoma ruled largely in favor of the state in PCMA v. Mulready, upholding most of the Oklahoma law against a federal preemption challenge. In August, PCMA appealed that decision to the U.S. Court of Appeals for the Tenth Circuit, asserting that only four of the provisions are preempted by ERISA and Medicare Part D, retreating from the 14 it originally had challenged. No date has been set for oral arguments. 


Last Nov. 29, American Pharmacies and key allies filed an amicus brief with a federal appeals court to defend a Louisiana law giving the state authority to regulate Medicare Part D claims. In July 2021, APRx filed an amicus brief (joined by the Alliance for Transparent and Affordable Prescriptions and the Community Oncologist Alliance) in PCMA v Wehbi in defense of North Dakota's PBM reform laws. 


We are closely following a Tennessee case brought by an ERISA plan to drive an American Pharmacies member, ThriftyMedPlus, from its network in violation of a Tennessee PBM reform law. We are also closely following a recent case by the Minnesota Department of Commerce against Caremark for violating Minnesota’s anti-steering law. It is likely that Caremark will assert ERISA and/or Medicare Part D preemption in its defense.

Key State Legislatures at a Glance


Texas Legislature | Official Website  

Frequency: Biennial (every other year) | 120 Days

Number of Legislators: 181 – 31 Senators | 150 Representatives

2023 Session: Convenes Jan. 10 | Adjourns May 29 

Bill Filing Deadline: March 10

Effective Date for Bills: 90 days after adjournment unless a different date is specified in the bill; bills with an emergency clause take effect immediately upon signing by the governor. 


New Mexico Legislature | Official Website

Frequency: Annual –– a 60-day session each odd-numbered year and a 30-day “fiscal” session each even-numbered year. 

Number of Legislators: 112 – 42 Senators | 70 Representatives

2023 Session: Convenes Jan. 17 | Adjourns March 18

Bill Filing Deadline: Feb. 16

Effective Date for Bills: June 16 (all bills that are not general appropriation bills or do not have a specified date or emergency clause)


Tennessee General Assembly | Official Website

Frequency: Biennial (every other year) | 90 days

Number of Legislators: 132 – 33 Senators | 99 Representatives

Bill Filing Deadline: None

2023 Session: Convenes Jan. 10 | Adjourns April 26

Effective Date for Bills: 40 days after passage unless there is an emergency clause


Michigan Legislature | Official Website  

Frequency: Year-round

Number of Legislators: 148 – 38 Senators | 110 Representatives

2023 Session: Convenes Jan. 11 | Adjourns Dec. 31

Bill Filing Deadline: March 10

Effective Date of Legislation: If not specified and the bill passed by a two-thirds majority, the bill takes effect immediately. Bills that do not pass by a two-thirds majority become effective 90 days after adjournment.


Arizona State Legislature | Official Website

Frequency: Annual | 100 Days (can be extended by vote)

Number of Legislators: 90 – 30 Senators | 60 Representatives

2023 Session: Convenes Jan. 9 | Adjourns April 22

Bill Filing Deadline: Feb. 6

Effective Date for Bills: 90 days after adjournment; bills with an emergency clause take effect immediately upon signing by the governor


Florida Legislature | Official Website 

Frequency: Annual | 60 Days

Number of Legislators: 160 – 40 Senators | 120 Representatives

2023 Session: Convenes March 7 | Adjourns May 5

Bill Filing Deadline: March 7

Effective Date for Bills: 60 days after adjournment unless otherwise specified in the bill

We Need Your Support!

Community Pharmacy has many challenges. Powerful, well-funded interests work daily to cut your reimbursements, stifle competition and restrict patient's right to choose a pharmacy.


These vital issues are often decided by elected leaders who may not know the facts or appreciate your value to your community as a health-care provider. 


American Pharmacies is the strongest voice for independent pharmacy in the state advocacy arena. But we cannot succeed without your support, starting with the relationships you have with elected state leaders. No one has more influence with legislators than voting consitutents.


Please fill out our Grassroots Signup Form to send us your contact information, including an “anytime” phone number that rings directly to you. Thanks for your support – your involvement and relationships will be a vital contributor to our legislative successes.

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