| 41 | | - | 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, 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 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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| 41 | + | 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, that the Director of Health 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 to patient consumers, and increase access to health care; and BE IT FURTHER RESOLVED that the Director of Health, or the Director'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 Resolution be transmitted to the Director of Health, 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. OFFERED BY: _____________________________ Report Title: DOH; Pharmacy Benefit Manager; Working Group; Reform |
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