It is no secret that pharmacies across the Commonwealth are struggling to keep their doors open. Spotlight PA recently reported that nearly 800 licensed pharmacies have closed in Pennsylvania since 2020 according to Department of State records.
 
This problem is not unique to Pennsylvania. As the cost of prescription drugs continue to rise and inadequate reimbursement rates take a devastating toll on our community pharmacies, states have begun to explore potential solutions, including rethinking the Medicaid pharmacy benefit payment structure. Several states have fully carved out their Medicaid pharmacy benefit from managed care, which has proven to have significant cost savings. In fact, West Virgina reported $54.5 million in savings to its Medicaid program during the first year of implementing the carve-out.
 
Therefore, I intend to introduce legislation that will transition Pennsylvania’s Medical Assistance pharmacy benefit from managed care to a Fee-For-Service (FFS) program. Under the FFS delivery model, a state, rather than a Pharmacy Benefit Manager (PBM) contracting with a managed care organization (MCO), directly reimburses pharmacies for filling the prescriptions of Medicaid recipients. By centralizing drug purchasing and simplifying administration of pharmacy benefits, we can generate cost savings, ensure fair reimbursement for pharmacies, enhance transparency and create better outcomes for our local pharmacies and patients alike.
 
Please join me in co-sponsoring this important piece of legislation.