The mission of KPhA is to advocate and advance the pharmacy profession to improve the health of Kentuckians.

2022 PBM Reform

Rep Steve Sheldon (R-Bowling Green) filed HB203 to address the ongoing abuses from pharmacy benefit managers. The 40 page bill has been touted as one of the most comprehensive pieces of PBM legislation in the country. Below are a few highlights from bill:

  • Requires all PBM rebates be passed through to the patient at point of sale

  • Prohibits mandatory mail order pharmacy

  • Prohibits mandatory use of PBM affiliated pharmacies

  • Prohibits white and brown bagging - allowing patients to fill their medications where they choose

  • Prohibits limited preferred networks and copay differences for patients

  • Prohibits patient incentives to use PBM affiliated pharmacies 

  • Addresses contract changes and requires proper notification of changes throughout the contract period

  • Prohibits spread pricing models

  • Prohibits higher reimbursement to PBM affiliated pharmacies 

  • Sets a reimbursement floor of NADAC + $10.64 dispensing fee on commercial claims

  • Offers 340b protections to entity and contract pharmacies through non-discriminatory reimbursement language

  • Applies to all commercial plans in Kentucky, including the state health plan and ERISA plans

KPhA acknowledges Rep Sheldon's leadership and dedication to the profession as he and many others have worked tirelessly to draft this bill. Now, more than ever, we must unite as one voice and urge legislators to support this legislation. We face stern opposition from the PBM's who have endless resources to lobby against its passage, it will take us all but we can succeed. Click the button below to contact your legislator today!

HB203 - Talking Points

Link to HB203

Patient Resource  - Fight4Rx Campaign