Washington State Joint Select Committee, Health Care Oversight

Matthew J. DiLoreto, Senior Director State Government Affairs National Community Pharmacists Association

November 19, 2015

Introduction

Good morning honorable members of the Health Care Oversight, Joint Select Committee. My name is Matthew

DiLoreto and I am here on behalf of the National Community Pharmacists Association (NCPA). NCPA represents

the interests of approximately twenty-thousand independent small business owner, community pharmacists,

pharmacy franchises and small chains throughout the country. As the Senior Director of State Government

Affairs, my position involves managing and supporting NCPA’s state government affairs efforts in all 50 states as

well as supporting federal legislative efforts in Washington, DC. The vast majority of my work has involved

advocating for fair and reasonable reforms involving the Pharmacy Benefit Manager (PBM) and independent

pharmacy marketplace to ensure a fair, accessible, transparent and cost effective prescription drug delivery

system.

I will use my brief time today to cover a significant amount of information including; the role of PBMs; an

overview of the pharmacy, PBM, health plan and beneficiary relationships; current national and state efforts

regarding these relationships; and challenges those efforts are facing. Most importantly, I hope the overview of

these complex and often unfamiliar topics will spark a great deal of interest and questions from you as committee

members. I have conducted similar presentations across the nation to a variety of audiences, but it is important

to understand that those who oppose fair and reasonable legislative and regulatory reforms of the industry rely

on that complexity, and non-transparent nature more so than anything else to prevent necessary changes.

What is a Pharmacy Benefits Manager (PBM)

PBMs originated around the 1970s initially to process claims, validate patient eligibility and administer plan

benefits. Put simply, they were created to manage the complexity of the prescription drug benefit, which is,

administratively speaking, a different system to manage compared to other healthcare benefits. Over time, PBMs

have taken advantage of their strategic position as an intermediary between the insurer, payer, beneficiary and

healthcare provider to assert nearly total control over prescription drug transactions from the manufacturing level

all the way to dispensing the patient’s medication. This includes creating pharmacy networks and defining terms

and conditions of network participation; determining generic drug costs to the plan and reimbursement rates to

the provider; acting as pharmacy providers through the operation of massive mail-order pharmacy operations;

creating and managing drug formularies, thereby defining what medications can ultimately be dispensed to a

patient as well as other pharmacy benefit management activities. Despite their ubiquitous role, PBMs operate

with extremely limited oversight or regulation of any kind. As a result, the PBM business has proven to be

extremely profitable with limited corresponding risk.

While the largest PBMs have enjoyed staggering revenue and market share growth, they have also faced

widespread allegations of fraud; misrepresentation to plans, patients, and providers; improper therapeutic

substitution; unjust enrichment through secret kickback schemes; and failure to meet ethical and safety

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standards1. The industry has continually opposed any efforts to ensure a reasonable level of transparency,

oversight or regulation over their profitable business model. PBMs often claim that they are regulated at many

levels yet, whenever any governing entity attempts to define what that regulation may be - or utilize it - the PBM

industry aggressively fights back through advocacy, litigation and public relations campaigns.

Pharmacy Benefit Manager (PBM) Business Model

PBMs Market Power and Influence

The PBM marketplace is dominated by a small number of extremely large corporations: Express Scripts (ESI),

Caremark (CMK) and OptumRx. Annual revenues for Express Scripts® alone in 2014 were approximately $100.9

billion, while CVS/caremark® had the highest revenues of the “Big Three” coming in at $139.4 billion in 2014.2,3

Finally, OptumRx® reported $32 billion in annual revenues in 2014.4 NCPA respectfully requests that you keep

these staggering figures in mind when a PBM may state that a singular small business owner, in a rural

Washington community, has the ability to fairly negotiate network participation or reimbursement terms with

one of these corporate behemoths.

Express Scripts (ESI) is ranked twenty-two on Fortune 500 rankings and processes more than one billion

prescriptions each year. ESI covers approximately 85 million lives, making it the largest PBM in the country.5,6

Express Scripts maintains network contracts with more than 69,000 retail pharmacies as well as offering home

delivery (mail-order) services of prescriptions. In addition to contracting with retail pharmacies which comprises

98.4% of their business, ESI also receives revenue from their specialty drug pharmacies, home delivery pharmacies

and fertility pharmacies.7

CVS/Caremark, now CVS/Health is currently ranked 10 on the Fortune 500 list. CVS/Health works with almost

68,000 retail pharmacies which includes their own CVS stores as well as 27,000 independent pharmacies.8 This

alone poses serious concerns for independent community pharmacy. A corporation responsible for their

reimbursement and contracting purposes also owns its own retail pharmacy and its own mail-order pharmacy.

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In other words, independent pharmacies are required to contract with a direct competitor. CVS/Caremark covers

approximately 65 million patient lives and processed more than 930 million prescriptions in 2014.9

UnitedHealthcare®, operates its PBM business under OptumRx, which covers more than 30 million Americans and

processes more than 600 million prescriptions each year.10 OptumRx’s network consists of more than 67,000

retail pharmacies and includes two home delivery pharmacies.

In summary, the PBM controls virtually everything involving the prescription drug delivery system. PBMs are

extremely influential and profitable all the while managing to stay under the radar. PBMs dictate how much

pharmacies will be paid for the drugs they dispense regardless of the pharmacies’ acquisition costs. At the same

time, the PBM bills the health plan sponsor for those same drugs, often without providing any transparency about

the actual costs. They determine which pharmacies are permitted to operate in a given network, which in essence

“steers” the patient to a particular pharmacy provider. PBMs operate their own mail-order pharmacies which

directly compete with community pharmacies, especially when the PBMs incentivize or mandate that patients

obtain their medications through mail-order no matter what option the patient feels best serves their healthcare

needs. Finally, PBMs have the authority to audit pharmacies and in most cases there are no defined rules or

regulations over what can be considered a recoupable offense. In summary, PBMs dictate who an independent

community pharmacy can serve and how much they will pay pharmacies for the products they dispense all

without any meaningful oversight at the state or federal level. NCPA is aware of no other industry – particularly in

the healthcare space -- that operates in this manner.

A National Movement Toward Greater PBM Oversight & Transparency

Across the nation, state and federal legislatures and regulatory departments alike have begun to pay greater

attention to the questionable practices of the PBM industry and how such practices impact both the healthcare

delivery marketplace, business community and beneficiaries. While most activity is occurring at the state level,

the Centers for Medicare and Medicaid Services (CMS), the United States Congress, the United States Department

of Labor (DOL) and others have introduced legislation, conducted hearings, issued proposed or final guidance and

made formal recommendations to implement a greater degree of transparency and oversight over the PBM

business model. In fact, as recently as Tuesday of this week, the United States House Judiciary Committee,

Subcommittee on Anti-Trust conducted a hearing on PBM and Pharmacy Marketplace related issues at which

NCPA testified.

STATE PBM REFORM LAWS

Issue Number of States

Generic Drug Pricing Transparency 24 (25 upon NY governor’s signature)

Fair and Uniform Pharmacy Audits 33

Anti-Mandatory Mail Order 8

Medication Synchronization 12

Of all the PBM issues under consideration at the state and federal levels, Generic Drug Pricing Transparency

(referred to as “MAC transparency”) has experienced the most attention. Enactment of legislation providing for

greater transparency into how generic drugs are priced, timely updates to reimbursement prices to providers, and

an ability for providers to challenge egregious pricing practices, has now been enacted in 24 states, including

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Washington. During the past year, states have taken previous state enacted or model language to another level in

an attempt to prevent PBM manipulation and circumvention of the intent of the transparency laws. This past

legislative session, Georgia enacted a law to require greater transparency standards regarding generic drug

reimbursements.11 Georgia was the first state to attempt to close statutory loopholes that PBMs used to avoid

compliance with generic drug pricing transparency laws in other states. Most notably, Ohio signed similar pricing

transparency provisions into their budget bill. However, Ohio included additional key provisions. First, Ohio

requires the PBM to disclose pricing to the plan sponsor as well as the pharmacy. Second, Ohio includes a

provision that gives enforcement authority to the state Superintendent of Insurance. 12 Such an enforcement

provision is absolutely vital to proper implementation of these laws.

In addition to traction at the state level, the United States Center for Medicare and Medicaid Services (CMS)

requires generic drug pricing transparency within the Medicare Part D program beginning in 2016.13 The simple

fact is that both state and federal entities recognize that having absolutely no transparency for how generic

medications are priced, all while massive price fluctuations are occurring in the marketplace, is not an efficient,

fair or reasonable manner to ensure a cost-effective healthcare delivery system. If an entity such as a PBM has

the ability to pay pharmacies one amount, bill the payer another and not provide any information as to the

difference paid/billed, how can anyone ensure a fair and cost effective benefit? As Pharmacy Outcome Specialists,

a national consulting firm that advises national business, union and government clients on prescription drug

benefits, indicated during DOL hearings:

“PBMs routinely decline to disclose that they are being paid by adding costs on to prescription drug claims. If

they do disclose that spread pricing is occurring, the amount of spread is not disclosed. No one has a problem with

PBMs making money or making a profit. But not knowing what the PBM is charging a client makes it nearly

impossible to evaluate the quality of the services provided against the cost of those services.”14

NCPA was pleased to be involved with last year’s DOL ERISA Advisory Council. The Council recommended that

PBMs disclose to self-insured health plan sponsors all forms of direct and indirect compensation PBMs receive in

association with providing pharmacy benefit services. The Council also recommended that the Department of

Labor pursue issuing guidance to assist health plan sponsors in determining whether and how to conduct a PBM

audit of such direct and indirect compensation. This recommendation was issued after hearing from numerous

health plan sponsors about the lack of transparency and many different restrictions that PBMs impose on the

audit process to prevent greater transparency into their profit-making tactics. The call for greater transparency

was voiced by NCPA during two days of Advisory Council hearings as well as from other notable organizations

such as Princeton University, the University of Michigan, General Dynamics Corp. (on behalf of the HR Policy

Association, and Honeywell International, Inc.

Implementation & Enforcement Challenges

Although many states have attempted to implement critical and needed legislation to ensure a fair and

transparent prescription drug pricing system, the reality is that many states, including Washington, are facing

challenges with proper enforcement and compliance with Generic Drug Pricing Transparency laws. In order to

determine the effectiveness of many recently enacted transparency laws, NCPA conducted a national survey of its

membership. The survey revealed that approximately 50% of NCPA members in states with pricing transparency

laws in place felt that there was little to no change involving PBM practices despite the enactment of the laws.

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The data revealed that although the intent of the legislation was to increase pricing and billing transparency,

PBMs were simply failing to comply, intentionally circumventing the provisions of these laws or, in some cases,

filing lawsuits to prevent the laws from being implemented. The data also demonstrated the need for additional

provisions in the laws including specific enforcement provisions and a designated enforcement entity. The PBMs’

conduct is requiring some states to revisit and/or amend their earlier enacted laws to ensure proper

implementation and compliance of existing provisions.

Independent community pharmacy has taken on the challenge of strengthening existing transparency laws with

more specific and clarifying language with the knowledge that that retaliatory action from the PBM industry is not

only possible, but unfortunately very likely. In a number of states, PBMs have issued contract amendments to

providers that drastically reduce reimbursement rates and institute a number of other retaliatory actions. Again,

as stated above, providers must decide to accept new and more onerous terms or not be able to fill prescriptions

for beneficiaries, many of whom are long-standing customers. In one state, a unilateral PBM amendment

blatantly stated that it was issued in response to a newly enacted law. The issued amendment closed by stating

that if the state repealed the law, the PBM could then void the amendment. In another state, a PBM issued notice

to an entity responsible for pharmacy contracting services that they would no longer do business with that entity

due to the number of generic drug pricing appeals the entity had submitted to that PBM. In essence, the PBM

was terminating the contract because this particular entity was doing its job too effectively.

The Pharmaceutical Care Management Association (PCMA), the national association representing the PBM

industry, has also filed lawsuits in two states challenging Generic Drug Pricing Transparency laws -- again

demonstrating that when a state enacts an effective law, the PBM industry will go to any length to prevent

transparency in their business model, especially regarding the cost of their services. NCPA is happy to report that

in one of those states (Iowa) the U.S. District Court dismissed all of PCMA’s claims including the PBMs’ “go to”

argument that the state law was preempted by ERISA.15 PCMA also filed a legal challenge in Arkansas, a state that

enacted a groundbreaking transparency and reform law that is being considered the new, national model for PBM

oversight. This lawsuit is ongoing, with preliminary hearings occurring two weeks ago. Many of PCMA’s claims in

Arkansas are similar to those made in Iowa, and NCPA is hopeful that the judge in Arkansas will echo the Iowa

decision.

NCPA reports these situations to members of the committee not as a deterrent to clarifying, strengthening and

enforcing your existing law, but instead to demonstrate pharmacy’s need to have the full support and

understanding of the legislature and regulatory authorities. The proposed provisions within legislation such as

Washington’s Senate Bill (SB) 5857 do not represent pharmacy “overreaching” or expansion of the intent of the

previously enacted law. In fact, we wish that the PBM industry would comply with the previously enacted law so

that the state does not need to revisit statutory language time and again. The unfortunate fact is that the

proposed language in the current version of SB 5857 are provisions that are simply needed to prevent the PBMs

from avoiding or abusing the existing law. As an NCPA representative who has been involved in the development,

drafting and enactment of many of these laws, including a new national model, I can confidently report that the

provisions contained in the legislation under consideration by the Washington legislature are very reasonable and

do not go nearly as far as what other states are enacting or that most are currently considering. That is not to say

the proposed amendments are not needed – they are critical.

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Conclusion

This testimony demonstrates the need for states to support legislation and pass laws that provide a needed

degree of transparency and reform of the PBM business model while simultaneously implementing oversight and

enforcement provisions necessary to ensure proper compliance with those laws. It also demonstrates the need

for states who have previously enacted laws to revisit those existing laws and amend them if necessary to ensure

proper enforcement, oversight and implementation.

There will be those who will voice many arguments against state efforts to strengthen Washington’s existing law.

They may also enlist the support of other organizations to do so. They will likely claim that costs will increase in

response to supporting this legislation. However, recall that this was the exact same argument made when

Washington originally enacted its law two years ago. As far as NCPA is aware, no state that has enacted similar, or

even stronger legislation, has noted any increase in costs. Nevertheless, the PBMs have used this argument in

every state that considered pricing transparency legislation, and also in Medicare Part D.

Perhaps the most misunderstood aspect of the PBMs’ cost increase argument is that pharmacy does not

determine the prices for the prescriptions dispensed to beneficiaries. Transparency and oversight legislation

originated because pharmacy owners didn’t even have access to what it would be reimbursed for the services it

provided and nowhere to turn to seek protection from particular business practices. The legislative efforts in

question only mandate greater transparency and oversight. Therefore, by its own business model, the PBM is the

entity which determines the cost to the pharmacy, reimbursement to pharmacy and cost to the health plan itself.

If there is any associated cost increase, we ask those considering legislative action to understand that costs are

solely in the control of the PBM. Also consider why PBMs, a hundreds-of-billions dollars industry, believe that

they will need to increase costs simply because Washington ensures reasonable transparency and audit

provisions.

In conclusion, independent community pharmacy, the small business owners and healthcare providers of

Washington, call on your support of state efforts to strengthen the degree of transparency and oversight of the

PBM industry. We respectfully request that you support Washington businesses and join the national trend of

states taking needed steps to ensure a fair, cost effective and transparent prescription drug delivery system. We

also respectfully request that you remain skeptical of the commonly utilized, but ultimately unfounded,

arguments from those opposing such reasonable reforms.

1 See Fighting Fraud and Waste in Medicare and Medicaid, Hearing Before a Subcomm. of the Comm. On Appropriates of the Senate (Feb. 15, 2011) (available at http://www.gpo.gov/fdsys/pkg/CHRG-112shrg64653/html/CHRG-112shrg64653.htm) 2 Express Scripts Annual Report, 2014. http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-reportsAnnual 3 CVS Health 2014 Annual Report: http://investors.cvshealth.com/~/media/Files/C/CVS-IR-v3/reports/cvs-ar-2014.pdf 4 United States Security and Exchange Commission Form 10-K, UnitedHealth Group®. For Fiscal year ended December 31, 2014. http://www.unitedhealthgroup.com/investors/~/media/5768123D517245FBB450B54F73E5E1CD.ashx 5 Express Scripts Annual Report, 2014. http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-reportsAnnual 6 The Wall Street Journal, January 26, 2015. The Big Issue Has Not Been choice, But Access: Express Scripts’’ Miller Explains. http://blogs.wsj.com/pharmalot/2015/01/06/the-big-issue-has-not-been-choice-but-access-express-scripts-miller-explains/ 7 Express Scripts Annual Report, 2014. http://phx.corporate-ir.net/phoenix.zhtml?c=69641&p=irol-reportsAnnual 8 CVS Health 2014 Annual Report: http://investors.cvshealth.com/~/media/Files/C/CVS-IR-v3/reports/cvs-ar-2014.pdf 9 Ibid. 10 United States Security and Exchange Commission Form 10-K, UnitedHealth Group®. For Fiscal year ended December 31, 2014. http://www.unitedhealthgroup.com/investors/~/media/5768123D517245FBB450B54F73E5E1CD.ashx

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11 Georgia HB 470: http://www.legis.ga.gov/legislation/en-US/Display/20152016/HB/470 12 Ohio HB 64: https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-HB-64 13 42 CFR Parts 417, 422, 423, et al. Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs; Final Rule 14 Pharmacy Outcome Specialists, Susan Hayes; President, http://www.dol.gov/ebsa/pdf/AChayes082014.pdf 15 Pharm. Care Mgmt. Ass’n v. Gerhart, et al., No. 4:14-CV-00345, Dkt. 117 (S.D. Iowa Sept. 8, 2015) (order granting motion to dismiss); Pharm. Care Mgmt. Ass’n v. Gerhart, et al., No. 4:14-CV-00345, Dkt. 56 (S.D. Iowa Feb. 18, 2015) (order granting motion to dismiss).

NATIONAL COMMUNITY PHARMACISTS ASSOCIATION

2012–2015 NCPA State Legislative Update

2012-2015 NCPA Legislative Update 1

Transparency

Kentucky (2013) S.B. 107

Kentucky Pharmacists successfully passed S.B. 107 through

both chambers of the legislature by unanimous votes before

being signed by Governor Steve Beshear (D).

Arkansas (2013) S.B. 1138

Arkansas’ bill passed the Senate unanimously with one vote

against in the House.

North Dakota (2013) H.B. 1363

North Dakota’s legislation passed both chambers

unanimously. Upon its final days within the legislative

process Express Scripts supported the legislations

movement.

Texas (2013) S.B. 1106

Texas’ law provides for MAC Transparency under the

Medicaid managed care program. This bill passed both

chambers by unanimous votes.

Oregon (2013) H.B. 2123 (MAC, Audit and PBM

registration)

Oregon’s legislation passed both chambers by a unanimous

vote and took numerous steps to reform the PBM/pharmacy

relationship. Governor John Kitzhaber (D) signed the bill

July 1, 2013. PBMs went neutral on the bill.

Iowa (2014) H.F. 2297

Iowa’s legislation passed the House and Senate

unanimously on Tuesday, March 4, 2014. The bill was

signed by Governor Terry Branstad on March 14, 2014.

New Mexico (2014) H.B. 126 (MAC and PBM

Registration)

New Mexico’s bill passed the House unanimously. Governor

Susana Martinez signed the bill in to law on March 5, 2014.

Washington (2014) ESSB 6137 (MAC, Audit and PBM

Registration) Washington’s S.B. 6137 requires PBMs to

register with the State Department of Revenue. It also

reforms the practice of pharmacy audits and provides for

increased MAC transparency. Governor Jay Inslee (D)

signed the legislation on April 2, 2014.

Utah (2014) H.B. 113

Utah’s H.B. 113 passed both chambers by unanimous votes

before being signed by Governor Gary Herbert (R) on March

31, 2014.

Tennessee (2014) S.B. 1991/H.B. 1554

Tennessee’s MAC legislation passed the House and Senate

on April 14th . Governor Haslam signed the bill on May 16th.

Maryland (2014) S.B. 952/H.B. 793

Maryland’s MAC legislation passed the House and Senate on

April 5th. The legislation was signed into law on May 5,

2014.

Colorado (2014) H.B. 14-1213

Colorado’s MAC legislation, very similar to Maryland's

legislation, passed the second chamber (Senate) on April

28th and was signed by Governor Hickenlooper on June 6,

2014.

Oklahoma (2014) H.B. 2100

Oklahoma's PBM reform legislation, containing MAC

transparency provisions, was signed by Governor Mary

Fallin on May 12, 2014

Louisiana (2014) S.B. 410

Louisiana’s MAC legislation was signed by Governor Bobby

Jindal on May 30, 2014.

Michigan (2014) S.B. 656

Michigan’s MAC legislation provides MAC transparency for

state plans. The bill was signed by Governor Snyder on June

16, 2014.

NATIONAL COMMUNITY PHARMACISTS ASSOCIATION

2012–2015 NCPA State Legislative Update

2012-2015 NCPA Legislative Update 2

Minnesota (2014) Omnibus Budget Amendment

Minnesota successfully enacted MAC transparency

standards into an omnibus budget bill.

Virginia (2015) H.B. 2031

The bill was signed by the Governor on March 27, 2015.

Arkansas (2015) S.B. 688 MAC Strengthen

Governor Hutchinson signed S.B. 688 into law on April 1,

2015 which will strengthen Arkansas’s existing MAC law

(enacted in 2013).

Georgia (2015) H.B. 470

Georgia’s legislation took steps to strengthen the state’s

existing fair pharmacy audit law and implement MAC

transparency standards. The Governor Deal signed the

legislation on May 5, 2015.

Florida (2015) H.B. 1049

This bill was signed by Governor Scott on June 10, 2015.

Montana (2015) S.B. 211

This bill was signed by Governor Bullock on May 5, 2015.

Texas (2015) S.B. 332

This bill was signed by Governor Abbott on June 16, 2015.

Ohio (2015) H.B. 64 – Budget Bill

This bill was signed into law by Governor Kasich on June 30,

2015.

Hawaii (2015) H.B. 252

This bill was signed by Governor Ige on July 2, 2015.

Wisconsin (2015) S.B. 21 – Budget Bill

This bill was signed by Governor Walker on July 13, 2015.

California (2015) A.B. 627

This bill was signed by Governor Brown on July 13, 2015.

Registration/Licensure

Oregon (2013) H.B. 2123 (MAC, Audit and PBM

registration)

Oregon’s H.B. 2123 requires PBMs to register with Oregon’s

Insurance Division. It also reforms the practice of pharmacy

audits and provides for increased MAC transparency.

Governor John Kitzhaber (D) signed the legislation July 1,

2013.

Washington (2014) ESSB 6137 (MAC, Audit and PBM

Registration) Washington’s S.B. 6137 requires PBMs to

register with Washington State’s Department of Revenue. It

also reforms the practice of pharmacy audits and provides

for increased MAC transparency. Governor Jay Inslee (D)

signed the legislation April 2, 2014.

Oklahoma (2014) H.B. 2100

Oklahoma's PBM reform legislation, requiring PBM

registration, was signed by the Governor on May 12, 2014.

Anti-Mandatory Mail Order “AMMO”

Pennsylvania (2012) S.B. 201 / Act 207

Act 207 prohibits a copayment, deductible, fee, limitation on

benefits or other condition or requirement for the coverage

of prescription drugs when not imposed on the covered

individual with a mail order pharmacy. Pennsylvania

became the second state in the nation to enact anti-

mandatory mail order legislation following New York in

2011.

Hawaii (2013) H.B. 65

H.B. 65 allows a retail pharmacy to enter into a contractual

retail pharmacy network. This bill grants a patient the right

to purchase their prescriptions at a contracted pharmacy

instead of being required to purchase their medications

through a mail order pharmacy owned by the PBM.

Arkansas (2015) S.B. 487

This law addresses PBM registration as a third party

administrator and will ideally develop a more structured

NATIONAL COMMUNITY PHARMACISTS ASSOCIATION

2012–2015 NCPA State Legislative Update

2012-2015 NCPA Legislative Update 3

pathway for PBM enforcement and oversight.

Fair and Uniform Pharmacy Audits

New Fair and Uniform Audit Laws

South Dakota: S.B. 133 signed 3/8/2013

Montana: S.B. 235 signed 3/28/2013

Colorado: H.B. 13-1221 signed 4/8/2013

Alabama: S.B. 283 (2012); effective 8/1/2012

California: S.B. 1195 (2012); effective 1/1/2013

Indiana: S.B. 407 (2012); effective 7/1/2012

Louisiana: S.B. 756 (2012); effective 8/1/2012

Minnesota: H.F. 1235/S.F. 973 (2012); effective

8/1/2012

South Carolina: S.B. 1269 (2012); effective 1/1/2013

Utah: H.B. 76 (2012); effective 5/8/2012

Vermont: S.B. 200 (2012); effective 7/1/2012

Texas: H.B. 1358 (2013); effective 9/1/2013

Oregon: H.B. 2123 (2013); effective 1/1/2014

New Hampshire: S.B. 38 (2013); effective 1/1/2014

Virginia: H.B.108 (2014)

Washington: ESSB 6137 (2014)

Florida: S.B. 702 (2014) effective 10/1/2014

Connecticut: S.B. 14 (2014); effective 10/1/2014

Massachusetts: S.2286 (2014); effective 1/1/2015

North Dakota: H.B. 1418; effective: 4/25/2011

Kansas H.B. 2182 (2011); effective 6/9/2011

Arkansas Title 17, Chapter 92; effective 4/3/2007

Kentucky Chapter 304, Subtitle 17A, Sections 1-5; Effective

3/24/2009

Missouri: Chapter 338 Section 338.600; effective 08/2009

New Mexico: Chapter 61 – Article 11 61-11-18.2;

Effective 7/01/2007

North Carolina: Ch. SL 2011-375; Effective: 6/27/2011

Oklahoma: Title 59, Section 356; Effective: 11/01/2008

Ohio: SB 258 signed 12/18/2014

Strengthened Pharmacy Audit Laws

Utah: S.B.194 signed 3/26/2014

Mississippi: H.B. 1490 (2012); effective 7/1/2012 Maryland: S.B. 903 (2012); effective 10/1/2012

Maine: L.D. 44 (2013); signed 5/7/2013 effective 9/2013;

Tennessee: S.B.63 signed 5/14/2014

Georgia: H.B. 179 signed 5/6/2014

Georgia: H.B.470 signed 5/5/2015

Medication Synchronization

Vermont: (2014) BCBS and MVP Health Care agreed to

implement prorated co-payments for patients who wish to

begin a medication synchronization program.

Colorado: HB 1359 (2014); effective 5/17/2014

Oregon: SB 1579 (2014); effective 1/1/2015

Utah: SB 210 (2014); effective 5/13/2014

Arizona: SB 1288 (2015); effective 7/3/2015

Kentucky: HB 140 (2015); effective 1/1/2016

New Mexico: HB 274 (2015); effective 6/19/2015

Washington: SB 5441/HB 1566 (2015); effective 7/24/2015

Maine: LD 810 (2015)

Connecticut: HB 5771 (2015); effective 7/1/2015

North Carolina: HB 97 (2015); effective 1/1/2016

NATIONAL COMMUNITY PHARMACISTS ASSOCIATION

2012–2015 NCPA State Legislative Update

2012-2015 NCPA Legislative Update 4

Community Pharmacy Legislative Victories

Issue Number of States

MAC Transparency 24

Fair and Uniform Pharmacy Audits 33

Anti-Mandatory Mail Order 8 (PA, NY, HI, TX, CT, AR, MD, LA—Medicaid and state employees only)

Registration/Licensure/Reporting 17

Medication Synchronization 12

Contact If you wish to discuss community pharmacies legislative efforts in a particular state, please contact NCPA State

Government Affairs at Matt.Diloreto@ncpanet.org or 703.600.1223.