In the near future, we plan to introduce legislation that will require pharmacies to submit drug price information to the Department of Human Services for purposes of establishing the actual acquisition costs of pharmacies in the Medical Assistance program.  The information submitted by pharmacies will include information such as invoice prices and all discounts, rebates, and refunds paid by distributors such as wholesalers and manufacturers known or anticipated to be paid to the pharmacy and that would apply to the net acquisition cost calculation of any drug products purchased.
 
The impetus for this legislation arose during a public hearing convened by the House Health Committee concerning whether to move the Commonwealth to a single pharmacy benefits administrator model in the Medical Assistance program.  Testimony revealed that the Department of Human Services does not have the ability upfront to know a pharmacy’s actual drug acquisition cost for a drug after all discounts and rebates are factored.  Without knowing the actual costs incurred, the Department cannot ensure that Medical Assistance managed care organizations (MA-MCOs) and pharmacy benefits managers (PBMs) are paying enough to cover the pharmacy’s acquisition costs for a drug and for the Department to determine when a different pricing model may be needed to better support pharmacies.
 
As we continue to debate different solutions to ensuring that our Medical Assistance program remains viable to serve those participants in the program, it has become apparent that without knowing the full costs of the program at each level, we cannot fully all the issues that exist.
 
We hope you will join us in supporting this legislation. Thank you for your consideration.