WISE EFFORT WOULD REDUCE HEALTHCARE COSTS FOR PRIVATELY INSURED KENTUCKIANS

WISE EFFORT WOULD REDUCE HEALTHCARE

COSTS FOR PRIVATELY INSURED KENTUCKIANS

Sen. Max Wise champions next effort in pharmacy benefit management reform

FRANKFORT, KY (February 8, 2024) - Sen. Max Wise, R-Campbellsville, continues to champion the cause of fair practices in pharmacy benefit management by introducing groundbreaking legislation to address the challenges faced by Kentucky pharmacies. The proposed legislation, Senate Bill (SB) 188, builds upon the success of Senator Wise's previous efforts, particularly his leadership in passing SB 50 during the 2020 Legislative Session.

The escalating issue of unfair pharmacy benefit manager (PBM) practices has led to the closure of 64 community pharmacies in Kentucky over the last two years, severely impacting access to medication for many Kentuckians. Drawing inspiration from successful PBM reform legislation in neighboring states, Wise's bill aims to empower citizens to choose where they purchase their medication, prevent further closures of community pharmacies, and ensure fair reimbursement rates for these essential healthcare providers.

SB 188 mirrors the principles of SB 50 imparting Medicaid, which limited the state to a single PBM and directed the Department of Medicaid Services to establish a single preferred drug list. SB 50 led to a substantial $282 million in cost avoidance for the Medicaid program according to legislative testimony from the Kentucky Cabinet for Health and Family Services during the 2023 Interim.

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said.

The key provisions of SB 188 include:

●       Prohibiting PBMs from mandating mail-order prescriptions.

●       Ensuring fair reimbursement rates for community pharmacies.

●       Preventing steering of patients to pharmacies owned by the PBM.

●       Allowing community pharmacies to fill 90-day prescriptions for maintenance drugs.

●       Prohibiting higher co-pays at community pharmacies compared to PBM-owned pharmacies.

●       Protecting community pharmacies from retaliation for providing cost-saving information to patients.

Additionally, the bill mandates that PBMs pay pharmacies at least the cost of the dispensed drugs, provide a fair dispensing fee, and include community pharmacies in their networks to offer patients the flexibility to choose a nearby pharmacy.

Wise's commitment to addressing the concerns of Kentucky's residents and rural communities is evident in his ongoing pursuit of legislative reforms. Wise’s SB 50, enacted during the 2020 Legislative Session, addressed payment issues between Kentucky Medicaid's drug middlemen and pharmacists, marking a significant milestone in rectifying PBM abuses. The bill's enactment reflected bipartisan collaboration, with Republican and Democratic lawmakers working alongside independent pharmacies to create a legislative solution. The bill established a single preferred drug list and placed the Department for Medicaid Services in charge of reimbursement methodologies, curbing unfair practices plaguing community pharmacies for years.

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Sen. Max Wise, R-Campbellsville, represents the 16th Senate District, including Adair, Allen, Metcalfe, Monroe, and Taylor Counties and eastern Warren County. Wise is the co-chair of the Interim Standing Committees on Economic Development and Workforce Investment; co-chair of the Tourism, Small Business, and Information Technology; and co-chair of the Task Force on School and Campus Security.

For a high-resolution .jpeg of Wise, please visit: https://legislature.ky.gov/Legislators%20Full%20Res%20Images/senate116.jpg

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