PBM Network Reform Acts Moving Forward in Tennessee and Vermont

Gov. Bill Lee (R-Tenn.) recently signed HB 2661 into law. The act requires PBMs to adopt reimbursement methods that accurately reflect actual acquisition costs and protect patients from being forced to use PBM-owned pharmacies.

In Vermont Gov. Phil Scott (R-Vt.) signed H. 353, a bill that addresses patient steering and also requires the state to look into issues such as reimbursement transparency, spread pricing, and other PBM practices that raise costs for patients and plans.

CVS Health had asked Gov. Phil Scott to veto H.353. H.353 started out as a bill to make drugs more affordable by regulating pharmacy benefits managers.

But revisions of the bill, as it worked its way through the House and Senate, would have all but guaranteed that specialty drug prescriptions given to patients in health care settings, including expensive cancer medication, would be filled at the University of Vermont Health Network’s pharmacy in Burlington, rather than through cheaper mail-order pharmacies that insurers prefer.

Though the language was softened somewhat in subsequent revisions, the final version of the bill, approved in the dwindling hours of this year’s legislative session, still gives UVM Health Network an advantage when it comes to filling those expensive prescriptions.

Private insurers countered that the legislation would force them to pay for more drugs to be dispensed at the only commercial specialty pharmacy in the state, UVM Health Network’s pharmacy in Burlington.

The UVM Medical Center Specialty Pharmacy offers access to a full range of pharmacy and support services and offers a convenient and personalized medication management that is close to home.

UVM clinical pharmacists and patient care coordinators are at the center of its patient management program providing support, medication education, and regular follow-ups to patients, caregivers and family members. Services include:

Takeaway: The trend of states proposing or enacting legislation to increase PBM transparency is increasing