Fort Smith, ARK – Arkansas lawmakers met on Monday to discuss a critical rule aimed at addressing the rising influence of pharmacy benefit managers (PBMs) on the state’s pharmacies and prescription drug prices. The rule in question, Rule 128, was introduced as a measure to ensure pharmacies are reimbursed fairly for dispensing medications. However, after more than five hours of debate, lawmakers deferred a vote on whether to make the rule permanent and will reconvene Thursday morning to continue their discussions.
PBMs, which serve as intermediaries between insurance companies, pharmaceutical manufacturers, and pharmacies, have long been criticized for driving up prescription drug costs. Pharmacies argue that PBMs inflate the prices they set for medications, leading to higher out-of-pocket expenses for patients while simultaneously reducing reimbursement rates to pharmacies. Lawmakers have expressed concern that these practices harm both pharmacies and consumers.
Rule 128 was created to ensure pharmacies are paid a fair and reasonable rate for filling prescriptions, with the goal of increasing transparency and accountability in the relationship between pharmacies and PBMs. The rule was initially passed as an emergency measure earlier this year, allowing the state to begin enforcing it immediately. On Monday, legislators discussed whether to extend the rule permanently, with a focus on balancing the interests of pharmacies, insurers, and consumers.
Senator Jonathan Dismang, a Republican from Beebe, voiced his opposition to the rule, raising concerns that the increased dispensing fees required under Rule 128 would be passed on to consumers. “The backbone of this rule is a dispensing fee that will fall on the back of consumers,” Dismang said. “I’m very much concerned about what that amount is, especially for the elderly and individuals with restricted incomes.”
Dismang’s remarks reflect broader concerns that rising drug prices could disproportionately impact vulnerable populations, such as senior citizens and low-income individuals who rely on prescription medications. His opposition to the rule is grounded in a belief that it may worsen affordability issues for Arkansas residents.
In contrast, Senator Justin Boyd, a pharmacist and co-owner of a pharmacy, spoke in favor of the rule. Boyd argued that while some price increases might occur, the rule would ultimately protect consumers from even higher costs in the absence of such regulation. “I’ve been hearing since 2015 that enacting this legislation will cause costs to go up,” Boyd said. “Maybe they do, but not by the ridiculous amounts that they tell us this specific rule is going to cause. My gut says that if we didn’t do anything, the costs were going to go up anyhow.”
Boyd emphasized that PBMs’ pricing practices have been a persistent issue for years, and without intervention, consumers and pharmacies could face even greater financial strain. His support for Rule 128 stems from his belief that it is a necessary step toward addressing the growing power of PBMs and their impact on the state’s healthcare system.
Despite differing opinions on the rule’s potential effects, lawmakers agreed that further action is likely needed to address the broader issue of PBM regulation. Several legislators indicated that legislation to hold PBMs more accountable will be a focal point in the upcoming legislative session.
Senator Dismang suggested that additional reforms might be necessary to improve the current framework and better regulate PBMs, with the goal of ensuring fairer pricing for both pharmacies and consumers. “We’ll likely see legislation looking to clean up the language in current laws to better hold PBMs accountable,” he said.
As the debate continues, both pharmacies and consumers will be closely watching the outcome, as the ongoing battle over PBM practices could have lasting implications for prescription drug pricing in Arkansas. Lawmakers will reconvene on Thursday to finalize their decision on Rule 128, with the possibility of further legislative action in the near future.