One significant competitive challenge that Washington State independent pharmacies face arises from pharmacy benefit managers (PBMs) steering patients to use their affiliated pharmacies for mail-order prescription pharmacy services. However, a Washington House Bill 1813 (“Bill”) aimed at addressing this practice is making its way through the Washington Legislature. If passed by the Senate and enacted into law, it would benefit independent pharmacies and give patients the choice to choose between PBM affiliated mail-order pharmacies and their community pharmacy. The Bill was unanimously passed by Washington’s House of Representatives and is now in the Senate’s Health and Long-Term Care Committee. If enacted, the Bill is set to take effect on January 1, 2023 and includes provisions that would prohibit PBMs from:
- Requiring patients to use a mail-order pharmacy;
- Requiring patients to obtain prescriptions from a mail-order pharmacy unless the prescription drug is a specialty or limited distribution drug; or
- Reimbursing patients’ chosen participating pharmacy an amount less than the amount the PBM reimburses participating affiliated pharmacies.
In addition, the Bill expressly requires PBMs to include a provision in pharmacy contracts that authorizes the pharmacy to decline to fill a prescription if the PBM refuses to reimburse the pharmacy at a rate that is at least equal to the pharmacy’s acquisition cost of the drug. Further, the Bill would require that patients’ copays be the same for patients who receive prescriptions via mail or at their community pharmacy. Finally, the Bill would permit a patient to receive delivery or medication through any pharmacy that is a participating pharmacy in a particular PBM’s network.
If enacted, the Bill significantly limits the ability of a PBM to provide preferential treatment toward its affiliated mail-order pharmacies to the detriment of independent pharmacies. This Bill is a substantial improvement and complement to Washington’s current laws and would provide independent pharmacies with new tools to combat improper PBM practices.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the U.S. in challenging PBM audits, network access, reimbursement practices and has extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including state PBM laws in effect in numerous states, including Washington, in addition to important federal laws which regulate PBM conduct.
