Legislative Advocacy Update

AB 317 would remove a major barrier for California’s pharmacists to bill commercial health plans for patient care services authorized by law. Pharmacists must be allowed to enroll in commercial health plan provider networks and bill for covered services. Pharmacists are well trained and positioned to increase access to care and relieve strain on the healthcare system.

The California Pharmacists Association (CPhA), who IPC partners with through shared advocacy support, states that the pandemic has shone a glaring light on the fragility of the healthcare system as providers and facilities were stretched beyond capacity. It made it very clear that pharmacists, as one of the most accessible health care providers, must be utilized to provide care that is within their scope of practice. Unfortunately, this will not happen until health plans are required to reimburse them for providing care. AB 317 has been sent to the Governor’s office for signature.

IPC’s Government Relations team has been lobbying Congress all year to enact PBM reform legislation. There is initial success with both current House PBM reform bill (H.R. 5378, “Lower Cost, More Transparency Act”) and the Senate version (S. 2973, “Modernizing and Ensuring PBM Accountability Act”) including these two provisions:

• Requiring state Medicaid managed care prescriptions reimbursement parity to the Medicaid fee-for-service rates NADAC for all drugs.
• Professional fee.

The senate versions also reforms Part D performance DIRs and prevents Part D plans from using limited networks for specialty drugs. Floor votes are expected on both bills. Stay tuned for updates.