Committee backs PBM-transparency bill after pharmacy, insurer testimony

The House Health and Human Services Committee voted to adopt Substitute 1 and favorably recommend House Bill 527, a measure aimed at improving transparency and accountability for pharmacy benefit managers (PBMs) and their use of maximum allowable cost (MAC) lists.

Representative Katie Hall, sponsor of the measure, said the bill seeks to provide pharmacies with meaningful information when reimbursements fall below acquisition cost and to strengthen the appeals process. Jeff Gatzmeyer, president of the Utah Pharmacy Association, told the committee pharmacies sometimes dispense prescriptions at a loss and that appeals rarely succeed: a 2025 survey of seven pharmacies produced about 1,900 MAC appeals and only 10 successful outcomes, he said.

SelectHealth and its PBM affiliate described their appeals process as robust, said they rely on national pricing benchmarks and warned that wholesalers’ proprietary contract pricing is not centrally visible. Jenny Barlow (SelectHealth/Scripius) said wholesale catalog prices and rebates often differ from a pharmacy’s net acquisition cost, and that requiring wholesale‑level disclosures could impose significant operational burdens.

Retail and patient advocates urged the committee to require PBMs to show how MAC prices are set and to improve the appeals process so pharmacies can remain open, particularly in rural areas. The committee adopted Sub 1 and voted to recommend HB 527 favorably to the floor.

Lawmakers and stakeholders said further technical refinement will be needed to balance transparency with practical constraints of supply‑chain data.