Two bills in before legislators designed to help local pharmacies

Legislators will have two bills to vote on during the 2024 Wyoming Legislative Session. Both should help local pharmacies.

SF0100 seeks prompt payment for insurance claims. Local legislators sponsoring the bill are Senator Ed Cooper, R-Ten Sleep, Senator Dan Laursen, R- Powell, and Rep. Dalton Banks, R- Cowley.

The bill reads in part: “An ACT relating to the insurance code; providing regulations for payment of claims from insurers or the insurer’s intermediary to pharmacies; providing definitions; requiring rulemaking; providing applicability; and providing for effect dates.”

Sponsor Senator Lynn Hutchings (R) Laramie stated the benefits via e-mail “SF0100, “Prompt payment of insurance claims,” is designed to benefit pharmacists and pharmacies, particularly small independent ones. It seeks to ensure timely and fair compensation by setting clear deadlines for claim payments and forbids PBMs from charging additional fees. This bill will offer greater financial stability to pharmacies and is a positive step forward in maintaining the viability of local pharmacies, enabling them to provide essential healthcare services to our communities.”

Basin Pharmacy Pharmacist Camilla Hancock explained further that there are times when a pharmacy must wait for 90 days or longer to get reimbursed for a prescription they have dispensed. These can run in the $1000’s. She notes, “Currently there is no statute and many of these companies drag out the time to payments for months, and even unfortunately even years. If all of us are required to pay our bills on time, why shouldn’t they?”

Pharmacist Craig Jones gave an example. “We have given a person their prescription that insurance covers, the pharmacy has already paid for the drug so the customer who needs it can have it. That drug may cost us $1000 to purchase, yet we don’t recoup that cost for months.”

Hutching’s summary of the bill was “The “Prompt payment of insurance claims” bill mandates timely payment of pharmacy claims. Electronic claims must be paid within 21 days, and non-electronic claims within 30 days. If a clean claim is not paid within the stipulated timeframe, PBMs must pay 18% annual interest to the pharmacy. The bill also outlines procedures for resubmitting claims and prohibits PBMs from charging pharmacies fees related to claim payments. Effective July 1, 2024, this bill aims to create a fairer and more transparent payment system for pharmacies.”

The second bill is HB0173. Rep. Banks is also a sponsor of this bill. It reads in part “AN ACT relating to pharmacy benefit mangers; amending provisions related to pharmacies and in network retail pharmacies; requiring rule making; specifying applicability; and providing for effective dates.”

Hancock said, “Its purpose is to make sure insurance companies allow patients their choice in pharmacy.” We encourage everyone to support these bills as both will help in the longevity of our local pharmacies.