The lone remaining bill intended to enhance the regulation and transparency of pharmacy benefit managers died Thursday after the Mississippi House of Representatives chose not to advance the Senate’s versions of the bill or pursue further negotiations on an issue that has long divided the chambers and lawmakers within them.
House Speaker Jason White attributed the bill’s failure to the Senate’s inclusion of language mandating a dispensing fee and called on Republican Gov. Tate Reeves to call a special session to address pharmacy benefit manager reform in a social media post.
“The Senate has repeatedly taken this legislation too far, placing the cost burden on the shoulders of Mississippi’s patients,” wrote White, who declined to answer reporters’ questions after the House adjourned Thursday.
The House’s original bill would have given independent pharmacists 90% of what they have been advocating for the past three years, he added.
White said he anticipates further negotiations and for interested parties to reach an agreement within the next few days.
Sen. Rita Parks, a Republican from Corinth who has spearheaded pharmacy benefit manager reform efforts in the Senate for years, said in a statement the outcome is “so disappointing.”
“This wasn’t about policy — it was about power,” she said. “And today, the power of Big Pharma outweighed the needs of Mississippi families and community pharmacists.”
Pharmacy benefit managers are the middlemen used by health insurance companies and self-insured employer plans. They have increasingly drawn scrutiny from policymakers because of their opaque business practices, market consolidation and concerns that their practices are leading to increased drug prices with little accountability.
Independent pharmacists have warned year after year that if legislators do not pass reform legislation, pharmacies may be forced to close. They say the companies’ low reimbursements and unfair business practices have left them struggling to break even.
Joe Mohamed, the president of the Mississippi Independent Pharmacies Association, said the bill’s failure is a missed opportunity for Mississippi patients and communities that depend on independent pharmacists.
“We stand ready to continue discussions throughout the remainder of the legislative session and beyond to ensure that Mississippi independent pharmacies remain viable and the patients they serve have access to the care they deserve,” said Mohamed, who is also the co-owner and pharmacist of G&P Pharmacy in Belzoni.
The Trump administration and Reeves have also gotten involved in the dispute.
In a memo dated March 18, the Trump administration urged the House to invite further negotiations on the bill to remove a provision that would interfere with TrumpRx, a government-run website launched in February that offers cash discounts for prescription drugs. The bill’s language defined sponsoring or providing cash discount cards as a pharmacy benefit management service.
The section of the Senate’s bill “could complicate the President’s policy and priority of providing access to the lowest prices on prescription medications for every American,” the memo read.
Reeves met with lawmakers this week to discuss the legislation.
In the meeting, Parks said, the governor encouraged the House and Senate to find language that could get pharmacy benefit manager reform passed.
“Obviously, that didn’t happen,” Parks said.
White said the governor has indicated he would be unlikely to sign the Senate’s version of the bill into law.
The House and Senate versions of the bill included similar provisions such as measures to increase transparency and prohibit spread pricing, or the practice of paying insurers more for drugs than pharmacists to inflate pharmacy benefit managers’ profits.
Several key differences emerged between the proposals.
The original version of House Bill 1665, authored by Rep. Hank Zuber, a Republican from Ocean Springs, would have moved the regulation of pharmacy benefit managers from the Board of Pharmacy to the Commissioner of Insurance.
Insurance Commissioner Mike Chaney told Mississippi Today the state agency would regulate pharmacy benefit managers if it was given the staff and funding to do so.
“We’re willing to run it if they give us the money and people to run it,” Chaney said.
The Senate’s version, authored by Parks, would have kept the regulation of pharmacy benefit managers at the Board of Pharmacy and added language to the House’s bill, which she said independent pharmacists requested to ensure they are paid fairly and transparently for dispensing drugs to patients.
Under the proposal, pharmacy benefit managers would be required to reimburse pharmacists at least as much as an affiliate pharmacy or the Mississippi Division of Medicaid, which covers the cost of the drug and a dispensing fee. Pharmacists have long said reimbursements for filling prescriptions are often lower than the cost to acquire and dispense the medications.
But some senators said the suggested payment structure would harm Mississippi businesses.
Sen. Jeremy England, a Republican from Vancleave and the most vocal opponent of the Senate’s version of the bill, said March 10 that the Senate’s proposed text would drive up the cost of prescriptions and health insurance, which would then be passed on to Mississippi businesses and their employees.
He presented a memo from the Legislative Budget Office estimating the bill would add $34 million in costs to the State Health Plan.
“This is bad policy,” England said. “This is going to cost our job creators money.”
Parks said the business community has consistently employed “scare tactics” that discourage legislators from voting for pharmacy benefit reform legislation but have provided little evidence that prescription drug costs will rise if the Legislature passes a bill that requires a specific reimbursement model.
On Thursday morning, Zuber said negotiations were ongoing between the House and the Senate.
“There’s still time,” he told Mississippi Today.
But less than an hour later, the House killed the bill by not voting to advance the Senate’s version or invite further negotiations before the deadline.
Last year, a pharmacy benefit reform bill made it to a similar stage in the legislative process but died in the House after a lawmaker raised a procedural challenge.
The options for reviving this year’s pharmacy benefit manager reform are limited. Lawmakers could introduce the text in a different bill, suspend the rules to revive the measure or the governor could convene a special session to address it.
Parks said the work to regulate pharmacy benefit managers in Mississippi would continue.
“While today’s result is disappointing, the fight for transparency and fairness in prescription drug pricing is far from over,” she said.
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