EPIC Rx Kicks Off 2023 Legislative Session with Three Main Priorities
By Brittany LaPorta
As the 2023 legislative session kicks off in many states, EPIC Rx stands poised to advocate on behalf of our member pharmacies. The EPIC Rx Government Affairs team is monitoring and engaging with state lawmakers on policies that advance and promote the business interests of community pharmacies.
Medicaid Managed Care Reform
Medicaid Pharmacy Carve Out is a legislative priority that is gaining momentum. For instance, in New York, the state plans for the Medicaid Managed Care Rx Program to be “carved out” and return to the Fee for Service Program.
Provider Status & Payment for Services
EPIC Rx monitors legislative proposals concerning pharmacists’ scope of practice, payment for pharmacist-provided services, and/or the classification of pharmacists as providers and supports such bills when applicable. One example is the “refusal to fill” protections in West Virginia.
PBM Reform/Enforcement of Existing State PBM Regulations
EPIC Rx generally supports PBM reform and the enforcement of existing state PBM regulations. PBMs are intermediaries between insurance companies, pharmacies, and drug manufacturers. To learn more about PBMs, and how PSAOs associate with them, check out our article “Differentiating Between PSAOs and PBMs” by EPN Vice President of Network Development Bretta Grinsteinner.
Protecting independent pharmacies and making PBMs more transparent is an ongoing fight. There are currently 133 laws in 46 states enforcing PBM reform, and the numbers are only increasing. PBM reform laws aim to reduce prescription drug costs and bring transparency to PBM practices.
Examples of 2023 PBM issues of concern include market conduct exams, patient steering, and white bagging:
- For Market Conduct Exams, it is important that PBMs be subject to examination to ensure their practices comply with the Public Health Service Act.
- Patient steering is where PBMs try to steer patients away from one pharmacy to another or to mail order.
- White bagging is when health insurers require providers to get specialty drugs through a specific pharmacy, usually associated with the insurance company.
Get Involved
Members can get involved in EPIC PharmPAC in a variety of ways. If you’re not a member and are interested in joining, or learning more about EPIC Rx, contact us today.
For more information, please visit:
‘Any Willing Provider’ Law Levels Playing Field for SP Contracts
State Drug Pricing Laws 2017-2023
“White Bagging” is No Good for Patients
Brittany LaPorta is EPIC Rx’s Director of Government Affairs. Brittany manages and coordinates state legislative and regulatory advocacy efforts for EPIC Pharmacies that protect the interests of community pharmacies.
Brittany earned her master’s degree in public administration from West Virginia University. She has years of experience in government affairs, specifically public policy and government relations.