Providing that pharmacy may decline to dispense prescription drug where reimbursement is less than pharmacy's cost
Impact
The passage of SB557 could significantly alter the landscape of drug reimbursement policies in West Virginia. By enabling pharmacies to refuse dispensing drugs based on reimbursement levels, the bill aims to mitigate the financial strain that pharmacies have experienced due to low reimbursements from PBMs. This change is expected to encourage PBMs to adjust their reimbursement methodologies to be more competitive and fair, particularly for community pharmacies that often face higher operational costs.
Summary
Senate Bill 557 aims to amend the West Virginia Code to provide certain rights to pharmacies and pharmacists regarding reimbursement for prescription drugs and pharmacy services. Specifically, it allows a pharmacy or pharmacist to decline to dispense a drug if the reimbursement offered by a public employee insurance program is less than their acquisition cost for that drug. The bill also stipulates that pharmacy benefit managers (PBMs) must report on various aspects of drug reimbursement and the number of declined prescriptions annually. This measure focuses on protecting pharmacies from operating at a loss and ensuring transparency in the reimbursement process.
Sentiment
The sentiment around SB557 appears to reflect concerns from the pharmacy community about the sustainability of their operations under current reimbursement models. Supporters, primarily from the pharmacy sector, view the bill as a necessary step towards fairness and financial viability. However, there may be apprehensions among some health insurance stakeholders who might worry about the potential for increased drug costs or restricted access to medications if pharmacies decline to fill prescriptions based on reimbursement issues.
Contention
A notable point of contention regarding SB557 is the broader implications for the relationship between pharmacies, PBMs, and health insurance plans. Opponents could argue that allowing pharmacies to refuse service based on reimbursement might lead to an imbalance, where patients might struggle to access their medications if local pharmacies choose not to dispense due to reimbursement costs. There is also concern about how this could affect the availability of certain prescription drugs, particularly in underserved areas.
Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.
Authorizes a pharmacist to decline to dispense a covered prescription drug if the coverage provider reimburses the pharmacy in an amount less than the drug's acquisition cost
Prescription drug pricing; modifying requirements of pharmacy benefits management; prohibiting prescription drug manufacturers from discriminating against certain drug pricing program. Effective date.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.