State lawmakers are considering legislation that would create a single Pharmacy Benefit Administrator model for all state-funded healthcare programs.

House Bill 2270, sponsored by Rep. Rob Matzie, D-Ambridge, has an uncertain future both because of a divided state legislature that can make passing major overhauls of state government programs difficult but also because the Shapiro administration says the change isn’t needed.

Our question after last week’s House Health Committee hearing is this: if not pharmacy benefit manager reform, then what? If the existing system isn’t sustainable for small pharmacy operations like Gaughn’s Drug Store, then what works?

Sally Kozak, who also testified before the House Health Committee this week, said those savings aren’t likely to materialize if Pennsylvania moves to a single PBM model. Kozak, the state deputy secretary of the Office of Medical Assistance Programs, told lawmakers that Pennsylvania has already made the specific changes that produced savings in other states. The change, she said, also wouldn’t solve the issues faced by pharmacies in Pennsylvania because state-funded healthcare programs are a relatively small share of the prescriptions filled each year.

Matzie’s bill would also change pharmacy payment rates that include directed payments using fee-for-service program pricing to all pharmacies. Kozak said that part of the legislation would eat up any administrative savings from switching to a single pharmacy benefits manager.

It is ludicrous to see pharmacies like Gaughn’s Drug Store struggling under the weight of reimbursement rates that are too low to fill many prescriptions without losing money each transaction. A state analysis released earlier this year found that requiring reimbursement based on National Average Drug Acquisition Cost pricing plus a $10.49 dispensing fee would likely redistribute payments rather than significantly increase total spending benefits while driving an additional $14 million in annual revenue to pharmacies. It’s worth discussing, in our opinion.

We’ve said it before, and we’ll say it again today: something has to change and it has to change soon. We have seen too many pharmacies in the state close their doors to continue down the dead end road we’re currently on when it comes to prescription drug reimbursements.