Senators debate PBM bill’s costs and exemptions as committee adopts amendment and advances measure to floor

The Banking and Insurance Full Committee advanced S342, a bill aimed at increasing transparency and minimum reimbursements from pharmacy benefit managers (PBMs), after a lengthy debate about cost impacts and who would bear increased reimbursement levels.

Dr. Gilbert described the measure as setting a reimbursement floor for pharmacies at 104% of NADAC (a national drug acquisition cost benchmark) and providing a dispensing fee equivalent to the current Medicaid professional dispensing fee. He said the bill also contains provisions addressing PBM steering and effective-rate programs; a multi-page subcommittee amendment and fiscal-impact materials were placed in members' packets.

The subcommittee chair (the senator from Dorchester) said the bill was reported out of subcommittee "with hesitation," noting it could help independent rural pharmacies but warns the marketplace is "extremely broken" and that it is unclear who ultimately bears the cost of higher reimbursements. The senator from Orangeburg illustrated potential cost impacts using round numbers — an illustrative calculation suggesting statewide additional costs in the hundreds of millions — and questioned exemptions for PEBA (the state employee health plan) that could be politically sensitive.

Other senators noted federal activity on PBMs, the difficulty of a state-only solution given national market concentration, and potential alternative steps such as expanding pharmacists' scope of practice to increase revenue opportunities. The committee adopted the subcommittee/committee amendment, voted to carry several desk amendments over to floor consideration, and ultimately voted to report S342 out to the floor for additional consideration and amendment.

Members repeatedly underscored uncertainty about the bill's effects and signaled a desire for additional stakeholder negotiation; several said they supported advancing the bill to create further conversation rather than settling the policy in committee alone.