Hawaii 2025 Regular Session

Hawaii Senate Bill SCR69 Compare Versions

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1		-	THE SENATE S.C.R. NO. 69 THIRTY-THIRD LEGISLATURE, 2025 S.D. 1 STATE OF HAWAII ~~H.D. 1~~ SENATE CONCURRENT RESOLUTION REQUESTING THE ADMINISTRATOR OF THE STATE HEALTH PLANNING AND DEVELOPMENT AGENCY TO CONVENE A PHARMACY BENEFIT MANAGER WORKING GROUP TO DETERMINE THE BEST POLICIES TO LOWER DRUG COSTS FOR PATIENT CONSUMERS AND INCREASE ACCESS TO HEALTH CARE.
	1	+	THE SENATE S.C.R. NO. 69 THIRTY-THIRD LEGISLATURE, 2025 S.D. 1 STATE OF HAWAII SENATE CONCURRENT RESOLUTION REQUESTING the administrator of the state health planning and development agency to convene a Pharmacy Benefit Manager Working Group to determine the best policies to reform Pharmacy Benefit Manager practices in the State to ENSURE TRANSPARENCY AND FAIRNESS FOR CONSUMERS AND IN THE PHARMACEUTICAL SECTOR, lower drug costs for patient consumers, and increase access to health care.
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3	3		THE SENATE S.C.R. NO. 69
4	4		THIRTY-THIRD LEGISLATURE, 2025 S.D. 1
5		-	STATE OF HAWAII ~~H.D. 1~~
	5	+	STATE OF HAWAII
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7	7		THE SENATE
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9	9		S.C.R. NO.
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11	11		69
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13	13		THIRTY-THIRD LEGISLATURE, 2025
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15	15		S.D. 1
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17	17		STATE OF HAWAII
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19		-	~~H.D. 1~~
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29	29		SENATE CONCURRENT
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31	31		RESOLUTION
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37		-	REQUESTING THE ADMINISTRATOR OF THE STATE HEALTH PLANNING AND DEVELOPMENT AGENCY TO CONVENE A PHARMACY BENEFIT MANAGER WORKING GROUP TO DETERMINE THE BEST POLICIES TO LOWER DRUG COSTS FOR PATIENT CONSUMERS AND INCREASE ACCESS TO HEALTH CARE.
	37	+	REQUESTING the administrator of the state health planning and development agency to convene a Pharmacy Benefit Manager Working Group to determine the best policies to reform Pharmacy Benefit Manager practices in the State to ENSURE TRANSPARENCY AND FAIRNESS FOR CONSUMERS AND IN THE PHARMACEUTICAL SECTOR, lower drug costs for patient consumers, and increase access to health care.
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45		-	WHEREAS, community pharmacies remain the most accessible health care locations, servicing remote and underserved communities with hours that often extend beyond those of other health care offices; and WHEREAS, medication price transparency and the reduction of medication costs are priorities of this body; and WHEREAS, over the past decade, the use of pharmacy benefit managers, who serve as the intermediary between pharmacies and insurance companies, has increased; and WHEREAS, other states have enacted a wide range of policies related to pharmacy benefit managers; and WHEREAS, Senate Bill No. 1509, introduced in the Regular Session of 2025, proposes to require pharmacy benefit managers and health insurers to pass on rebate savings to patient consumers to essentially create a reimbursement rate floor for, and prohibit spread pricing of, prescription drugs; now, therefore, BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is requested to convene a Pharmacy Benefit Manager Working Group to determine the best policies to lower drug costs for patient consumers and increase access to health care; and BE IT FURTHER RESOLVED that the Administrator of the State Health Planning and Development Agency, or the Administrator's designee, is requested to serve as chairperson of the Pharmacy Benefit Manager Working Group and to invite the following members to participate in the Working Group: (1) A representative from the Insurance Division of the Department of Commerce and Consumer Affairs; (2) A representative from the Department of the Attorney General; (3) A representative from the Med-QUEST Division of the Department of Human Services; (4) A representative from the Board of Pharmacy; (5) A representative from the Hawaii Pharmacists Association; (6) A representative from the National Community Pharmacists Association; (7) A representative from the Hawaii Association of Health Plans; (8) Two representatives from independent community pharmacies; (9) Two representatives from unaffiliated pharmacies; (10) Two representatives from the pharmacy benefit manager industry; and (11) One representative from the pharmacy benefit manager trade association; and BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to evaluate the following priority areas: (1) The appropriate state agency to oversee PBM practices; (2) PBM reporting requirements and intervals; (3) Fair pharmacy audit procedures; and (4) Protections from medication under-reimbursements; and BE IT FURTHER RESOLVED that in conducting its evaluation, the Pharmacy Benefit Manager Working Group is requested not to seek or request information that is proprietary, would be considered a trade secret, is protected by the Health Insurance Portability and Accountability Act of 1996, or would violate the Freedom of Information Act or any other federal or state law; and BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Commerce and Consumer Affairs, Attorney General, Director of Human Services, Administrator of the State Health Planning and Development Agency, Insurance Commissioner, Administrator of the Med-QUEST Division of the Department of Human Services, and Chair of the Board of Pharmacy. Report Title: SHPDA; Pharmacy Benefit Manager; Working Group; Reform
	43	+	WHEREAS, community pharmacies remain the most accessible health care locations, servicing remote and underserved communities with hours that often extend beyond those of other health care offices; and WHEREAS, medication price transparency and the reduction of medication costs are priorities of the Legislature; and WHEREAS, over the past decade, pharmacy benefit managers (PBMs), the intermediary between pharmacies and insurance companies, have morphed into large health care conglomerates that exercise control over every link in the prescription drug delivery chain; and WHEREAS, the largest health care conglomerates each own PBMs, who pay for pharmacy services, as well as the pharmacy chains that provide those services. This inherent conflict of interest results in higher drug costs for patients and increased profits for the corporate health care conglomerates; and WHEREAS, the three largest PBMs control eighty percent of the United States prescription drug market, profiting from the use of spread pricing models, also known as pay-to-play models, where the PBMs profit from the difference between what they charge health insurers for drugs and the amount they reimburse the pharmacies, which is often less than the actual costs for the pharmacies to acquire and dispense the drugs; and WHEREAS, the spread pricing model is criticized for incentivizing PBMs to charge more to health insurers, thereby leading to higher drug costs for patients, while negotiating lower reimbursement rates with pharmacies, leading to lower quality of care or restricted access to medications; and WHEREAS, both independent community pharmacies and unaffiliated pharmacies, or pharmacies that do not own or operate a PBM, are disproportionately affected by PBM price manipulation tactics and are ceasing operations at high rates across the country and in the State, impacting access to health care especially in rural areas; and WHEREAS, other states are enacting a wide range of PBM policy reforms that are resulting in millions of dollars in cost savings for the states, and their community pharmacies and patients, while simultaneously improving access to health care; and WHEREAS, oversight over PBMs is critically needed in the State to evaluate current PBM practices and their effects across the health care spectrum pertaining to both medication cost and access; and WHEREAS, S.B. No. 1509, introduced in the Regular Session of 2025, proposes to require PBMs and health insurers to pass on rebate savings to patient consumers to essentially create a reimbursement rate floor for and prohibit spread pricing of prescription drugs; and WHEREAS, the Legislature recognizes the urgent need for meaningful PBM policy reform to ensure transparency and fairness for consumers and in the pharmaceutical sector; now, therefore, BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is requested to convene a Pharmacy Benefit Manager Working Group to determine the best policies to reform PBM practices in the State to ensure transparency and fairness for consumers and in the pharmaceutical sector, lower drug costs for patient consumers, and increase access to health care; and BE IT FURTHER RESOLVED that the Administrator of the State Health Planning and Development Agency, or the Administrator's designee, is requested to serve as chairperson of the Pharmacy Benefit Manager Working Group and to invite the following members to participate in the Working Group: (1) A representative from the Insurance Division of the Department of Commerce and Consumer Affairs; (2) A representative from the Department of the Attorney General; (3) A representative from the MedQUEST Division of the Department of Human Services; (4) A representative from the Board of Pharmacy; (5) A representative from the Hawaii Pharmacists Association; (6) A representative from the National Community Pharmacists Association; (7) A representative from the Hawaii Association of Health Plans; (8) Two representatives from independent community pharmacies; and (9) Two representatives from unaffiliated pharmacies; and BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to evaluate the following priority areas: (1) The appropriate state agency to oversee PBM practices; (2) PBM reporting requirements and intervals; (3) Fair pharmacy audit procedures; (4) Protections from medication under-reimbursements; (5) Reimbursements to PBM-owned pharmacies compared to non-network or unaffiliated pharmacies; (6) Prohibitions against arbitrary accreditation requirements; and (7) Protections from patient steering practices; and BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Administrator of the State Health Planning and Development Agency, Director of Commerce and Consumer Affairs, Insurance Commissioner, Attorney General, Director of Human Services, Administrator of the Med-QUEST Division of the Department of Human Services, and Chair of the Board of Pharmacy. Report Title: SHPDA; Pharmacy Benefit Manager; Working Group; Reform
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47	45		WHEREAS, community pharmacies remain the most accessible health care locations, servicing remote and underserved communities with hours that often extend beyond those of other health care offices; and
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51		-	WHEREAS, medication price transparency and the reduction of medication costs are priorities of ~~this body~~; and
	49	+	WHEREAS, medication price transparency and the reduction of medication costs are priorities of the Legislature; and
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55		-	WHEREAS, over the past decade, ~~the use of~~ pharmacy benefit managers, ~~who serve as~~ the intermediary between pharmacies and insurance companies, ~~has increased~~; and
	53	+	WHEREAS, over the past decade, pharmacy benefit managers (PBMs), the intermediary between pharmacies and insurance companies, have morphed into large health care conglomerates that exercise control over every link in the prescription drug delivery chain; and
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59		-	WHEREAS, ~~other states have enacted a wide range~~ of ~~policies related to pharmacy benefit managers~~; and
	57	+	WHEREAS, the largest health care conglomerates each own PBMs, who pay for pharmacy services, as well as the pharmacy chains that provide those services. This inherent conflict of interest results in higher drug costs for patients and increased profits for the corporate health care conglomerates; and
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63		-	WHEREAS, ~~Senate Bill No.~~ ~~1509, introduced in~~ the ~~Regular Session~~ of ~~2025~~, ~~proposes~~ to ~~require pharmacy benefit managers and~~ health insurers ~~to pass on rebate savings~~ to ~~patient consumers to essentially create a reimbursement rate floor for,~~ and ~~prohibit spread pricing of, prescription~~ drugs; ~~now, therefore,~~
	61	+	WHEREAS, the three largest PBMs control eighty percent of the United States prescription drug market, profiting from the use of spread pricing models, also known as pay-to-play models, where the PBMs profit from the difference between what they charge health insurers for drugs and the amount they reimburse the pharmacies, which is often less than the actual costs for the pharmacies to acquire and dispense the drugs; and
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67		-	BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is requested to convene a Pharmacy Benefit Manager Working Group to determine the best policies to lower drug costs for patient consumers and increase access to health care; and
	65	+	WHEREAS, the spread pricing model is criticized for incentivizing PBMs to charge more to health insurers, thereby leading to higher drug costs for patients, while negotiating lower reimbursement rates with pharmacies, leading to lower quality of care or restricted access to medications; and
	66	+
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	69	+	WHEREAS, both independent community pharmacies and unaffiliated pharmacies, or pharmacies that do not own or operate a PBM, are disproportionately affected by PBM price manipulation tactics and are ceasing operations at high rates across the country and in the State, impacting access to health care especially in rural areas; and
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	73	+	WHEREAS, other states are enacting a wide range of PBM policy reforms that are resulting in millions of dollars in cost savings for the states, and their community pharmacies and patients, while simultaneously improving access to health care; and
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	77	+	WHEREAS, oversight over PBMs is critically needed in the State to evaluate current PBM practices and their effects across the health care spectrum pertaining to both medication cost and access; and
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	81	+	WHEREAS, S.B. No. 1509, introduced in the Regular Session of 2025, proposes to require PBMs and health insurers to pass on rebate savings to patient consumers to essentially create a reimbursement rate floor for and prohibit spread pricing of prescription drugs; and
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	85	+	WHEREAS, the Legislature recognizes the urgent need for meaningful PBM policy reform to ensure transparency and fairness for consumers and in the pharmaceutical sector; now, therefore,
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	89	+	BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2025, the House of Representatives concurring, that the Administrator of the State Health Planning and Development Agency is requested to convene a Pharmacy Benefit Manager Working Group to determine the best policies to reform PBM practices in the State to ensure transparency and fairness for consumers and in the pharmaceutical sector, lower drug costs for patient consumers, and increase access to health care; and
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71	93		BE IT FURTHER RESOLVED that the Administrator of the State Health Planning and Development Agency, or the Administrator's designee, is requested to serve as chairperson of the Pharmacy Benefit Manager Working Group and to invite the following members to participate in the Working Group:
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75	97		(1) A representative from the Insurance Division of the Department of Commerce and Consumer Affairs;
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79	101		(2) A representative from the Department of the Attorney General;
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83		-	(3) A representative from the ~~Med-QUEST~~ Division of the Department of Human Services;
	105	+	(3) A representative from the MedQUEST Division of the Department of Human Services;
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87	109		(4) A representative from the Board of Pharmacy;
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91	113		(5) A representative from the Hawaii Pharmacists Association;
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95	117		(6) A representative from the National Community Pharmacists Association;
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99	121		(7) A representative from the Hawaii Association of Health Plans;
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103		-	(8) Two representatives from independent community pharmacies;
	125	+	(8) Two representatives from independent community pharmacies; and
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105		-	(9) Two representatives from unaffiliated pharmacies;
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109		-	(10) Two representatives from the pharmacy benefit manager industry; and
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113		-	(11) One representative from the pharmacy benefit manager trade association; and
	127	+	(9) Two representatives from unaffiliated pharmacies; and
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117	131		BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to evaluate the following priority areas:
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121	135		(1) The appropriate state agency to oversee PBM practices;
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125	139		(2) PBM reporting requirements and intervals;
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129		-	(3) Fair pharmacy audit procedures; ~~and~~
	143	+	(3) Fair pharmacy audit procedures;
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133		-	(4) Protections from medication under-reimbursements; ~~and~~
	147	+	(4) Protections from medication under-reimbursements;
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137		-	BE IT FURTHER RESOLVED that in conducting its evaluation, the Pharmacy Benefit Manager Working Group is requested not to seek or request information that is proprietary, would be considered a trade secret, is protected by the Health Insurance Portability and Accountability Act of 1996, or would violate the Freedom of Information Act or any other federal or state law; and
	151	+	(5) Reimbursements to PBM-owned pharmacies compared to non-network or unaffiliated pharmacies;
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	155	+	(6) Prohibitions against arbitrary accreditation requirements; and
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	159	+	(7) Protections from patient steering practices; and
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141	163		BE IT FURTHER RESOLVED that the Pharmacy Benefit Manager Working Group is requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2026; and
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145		-	BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Commerce and Consumer Affairs, Attorney General, Director of Human Services, Administrator of the State Health Planning and Development Agency, Insurance Commissioner, Administrator of the Med-QUEST Division of the Department of Human Services, and Chair of the Board of Pharmacy.
	167	+	BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Administrator of the State Health Planning and Development Agency, Director of Commerce and Consumer Affairs, Insurance Commissioner, Attorney General, Director of Human Services, Administrator of the Med-QUEST Division of the Department of Human Services, and Chair of the Board of Pharmacy.
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147	175		Report Title:
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149	177		SHPDA; Pharmacy Benefit Manager; Working Group; Reform