JEFFERSON CITY — The Senate this week debated, but did not take action, on bills that would expand auditing protections for pharmacies and impose new transparency requirements on prescription drug pricing and insurance contracts.
Senate Bills 984 and 968 could put state restrictions on the activities of pharmacy benefit managers, which are widely viewed as a driving force behind rising prescription drug prices.
The benefit managers act as middlemen between insurers, pharmacies and drug manufacturers. They are responsible for negotiating drug prices, deciding which drugs are covered under insurance plans and handling payments between insurance companies and pharmacies.
Those activities would have more oversight under the bills.
The legislation would require a minimum 14-day notice for any on-site audit performed, an increase from the currently required seven-day notice. These audits would also have to identify what prescriptions are under review, with a maximum of 40 unique prescriptions and no more than 200 separately adjudicated claims, which would be selected at random.
No more than two of these audits can be conducted in a year unless there is reasonable suspicion that a pharmacy is conducting fraud.
Benefit managers would also be required to provide pharmacy claims data to plan sponsors, like employers or insurers.
The bill’s sponsor, Sen. Jill Carter, R-Granby, noted during floor debate Monday that the legislation has been in the works for several years, and the logistics of the bill were finalized after nine months of negotiations.
“I think we’re finally in a good place to ensure that the pharmacies are able to represent the best interests of their communities, but also at the same time, our insurance companies and all of the stakeholders are happy and content with the piece of legislation we have before the body,” she said.
One part of the bill caused debate over what several senators considered unfair restrictions. It that would require the Department of Commerce and Insurance to create a critical access care pharmacy program that would aim to support the sustainability of qualifying pharmacies in Missouri.
Both Sen. David Gregory, R-St. Louis, and Sen. Kurtis Gregory, R-Marshall, proposed amendments that would allow the program to extend to all pharmacies in Missouri.
“It’s difficult for me to justify saying, ‘Hey, we got a problem. And you know what we’re gonna do? We’re gonna fix it for some people,’” David Gregory said. “We should be fighting for all of those pharmacies if there’s a problem, all of them.”
Carter defended the clause and said it had been workshopped and discussed in detail throughout the past year.
“We’ve worked for the last nine months on (this) language with all the stakeholders, so the senators are a little late to the conversation,” she said. “The interest that he (David Gregory) spoke about, I mean, if he’s wanting to help pharmacies, this is the way to start to do that.”
The conversation ended momentarily after Kurtis Gregory’s amendment was not passed, but returned when David Gregory proposed his nearly identical amendment nearly a half hour later.
David Gregory again raised his concern that pharmacies in larger cities, like Kansas City or St. Louis, could be left out if his amendment is not passed.
“This body wants to say, we just want to fix that problem for some people,” he said. “We’re gonna pick winners and losers. We’ve heard that once or twice. It’s like, ‘Oh, it’s no big deal, these big guys, they can sustain it, they can handle it.’ Well, that’s not true.”
“We’re just gonna fix this big problem for some people,” he added. “Let’s do that, that’s good policy. It’s good thinking, and that’s why we came here. We came here to fix problems for some people.”
In response, Carter questioned whether some progress is better than no progress.
“Will you tell me what you think doing something for the greater good means?” Carter asked David Gregory. “I think having progress is the ‘greater good.’ I think having a conversation in this building for the last six to eight years and not being able to make progress hasn’t served anyone at all. And so to say, actually, we are getting more transparency.”
“What you’re doing is you’re harming the vast majority of consumers to help some few consumers,” she added. “That’s not the greater good. I think everybody who is in this sphere, insurance companies, the independent pharmacies, everybody who has a seat at the table doesn’t share your sentiment.”
The amendments by both senators were defeated. The bill was set aside for action at a later date.