Pennsylvania expands pharmacy choice in Medicaid managed care

Pennsylvania’s new fiscal code adds stronger protections for patients to keep using qualified pharmacies in Medicaid managed care networks, a bipartisan move advocates say could help preserve access in rural parts of the state. The change is aimed at limiting pharmacy benefit manager terminations and keeping trusted local pharmacies in network.

Why it matters: - Pennsylvania patients gained a stronger legal path to stay with their chosen pharmacy under Medicaid managed care. - The change could help independent and community pharmacies remain accessible in rural counties where pharmacy deserts have left many residents with fewer options. - Advocates say the shift matters because pharmacy network terminations can force patients to switch away from long-trusted local care.

What happened: - Pennsylvania’s fiscal code now includes language that strengthens protections for a patient’s right to choose a pharmacy. - The provision says a “qualifying pharmacy” must be contracted with by a managed care organization or pharmacy benefit manager. - A qualifying pharmacy must meet statutory conditions, including being in good standing with the Pennsylvania State Board of Pharmacy and the U.S. Drug Enforcement Administration. - The new language gives “shall” language more force than the earlier “any willing provider” standard. - The provision also sets criteria limiting when a pharmacy benefit manager may terminate a pharmacy that remains in good standing. - Pharmacists United for Truth & Transparency said the measure is a bipartisan legislative win for Pennsylvania patients.

The details: - The policy applies statewide. - Advocates say the language goes beyond the pharmacy access crisis that first drew lawmakers’ attention. - The provision is intended to prevent pharmacies from being re-litigated over issues that have already been reviewed and resolved. - Pennsylvania has 48 rural-designated counties, and advocates say those areas have been hit hard by pharmacy access problems. - The group said hundreds of thousands of residents in rural parts of the state face unreliable access to care because of pharmacy deserts. - PUTT said turning out to town halls, sharing stories and contacting lawmakers helped push the language into the fiscal code. - PUTT thanked legislators from both parties for supporting the change.

Between the lines: - The fiscal code language gives patients and local pharmacies a stronger lever in disputes with pharmacy benefit managers. - The bipartisan result suggests pharmacy access has become a cross-party consumer issue in Pennsylvania. - The emphasis on rural counties shows the debate is not only about network rules, but also about basic access to medication and neighborhood care. - PUTT framed the change as a partial win, not a final resolution, because pharmacy access problems remain.

What happened in Boswell: - More than 300 residents attended a community town hall in Boswell, Pennsylvania, last month to hear about pharmacy network terminations. - The panel included Cost Plus Drugs founder Mark Cuban, Somerset County Commissioner Pam Tokar-Ickes, Martella’s Pharmacies owner Jackie Martella and Gloria Gates CARE co-founder Dr. Zane Gates. - Monique Whitney, PUTT’s executive director, moderated the event.

What’s next: - PUTT said it will keep pressing until Pennsylvania patients can use the pharmacy they trust. - The group is also aiming to build on the fiscal code change with more advocacy from patients and lawmakers. - Ongoing pressure will likely focus on pharmacy benefit manager practices and broader access protections for independent pharmacies. - More information is available from PUTT.

The bottom line: - Pennsylvania tightened pharmacy choice protections, but advocates say the fight over access and PBM power is far from over.