Indiana Statehouse bills on local pharmacies and pharmacy benefit managers
PBM's act as middlemen when it comes to drug manufacturers and insurance companies. Plus, they play a vital role in what Hoosiers are paying at local pharmacies.
'These bills deal with reimbursement for pharmacies, and this is a huge issue that affects us across the state, including those in west central Indiana,' said Darren Covington, Executive Vice President of Indiana Pharmacy Association.
The Indiana Pharmacy Association is working diligently with legislation to pass multiple bills that ultimately require accountability and transparency between local pharmacies and pharmacy benefit managers.
State Bill 140 would require reimbursement for pharmacies by PBM's for dispensing drugs. The bill in place would also ensure that PBM's would not under-reimburse pharmacies below their costs. This would reduce the downstream effects of pharmacy closures, reduced staff or hours.
'Three of these bills are trying to correct that by requiring that PBM's reimburse pharmacies at cost. That's based on an average. We're not looking to make pharmacies have double digit profit margins here. That's not the aim of legislation. The aim of legislation is to make sure that pharmacies are reimbursed on average at cost so they can stay open and so that they can continue to serve the patients in their communities,' said Covington.
The bill also has a number of provisions related to patients' choice when it comes to choosing what pharmacy.
'The bills have provisions that would require the PBM to allow the patient to have the choice of the pharmacies. So that they want within network without fear of any penalty being imposed upon them.'
Lastly, House Bill 1606 will eliminate, and outlaw spread pricing by PBMs.
'House Bill 1606 has a specific provision regarding spread pricing. So spread pricing occurs when the PBM charges the health plan that they've contracted with a certain amount and then they reimburse the pharmacy at a lower cost and then keep profit. This will eliminate that.,' said the Executive Vice President of Indiana Pharmacy Association.
Moving forward, if the bills do not go get passed, local pharmacies can suffer.
'I think we'll continue to see more pharmacies close. The bills we're pursuing doesn't have an effective date until January 1st. I'm talking to pharmacies that don't know if they're going to be open by July,' said Covington.
If you are interested in supporting the PBM reform, Covington says you can contact your State Senator or State Representative here.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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