Requesting The Administrator Of The State Health Planning And Development Agency To Convene A Pharmacy Benefit Manager Working Group To Determine The Best Policies To Reform Pharmacy Benefit Manager Practices In The State To Ensure Transparency And Fairness For Consumers And In The Pharmaceutical Sector, Lower Drug Costs For Patient Consumers, And Increase Access To Health Care.
SR53 is a Senate resolution requesting the Administrator of the State Health Planning and Development Agency, or a designee, to convene a Pharmacy Benefit Manager (PBM) Working Group. The group is tasked with identifying policy options to reform PBM practices in Hawaii so as to improve transparency and fairness, reduce prescription drug costs for consumers, and increase access to health care. The resolution frames PBMs as powerful intermediaries in the drug supply chain and cites concerns about spread pricing, conflicts of interest, and the impact of PBM practices on community pharmacies and patients.
The working group would include representatives from state agencies and stakeholders such as the Insurance Division, Attorney General, Med-QUEST, the Board of Pharmacy, pharmacy associations, health plans, independent community pharmacies, and unaffiliated pharmacies. It is directed to study several specific issues, including which state agency should oversee PBMs, reporting requirements, audit procedures, reimbursement protections, differences in reimbursement between PBM-owned and non-network pharmacies, accreditation requirements, and patient steering. The group must report its findings and any proposed legislation to the Legislature before the 2026 Regular Session.
SR53 does not itself change Hawaii law, but it creates a formal legislative request for an interagency stakeholder working group to study PBM regulation and recommend reforms. Its practical impact is to advance the policy process around prescription drug pricing, pharmacy reimbursement, and PBM oversight, and it may lead to future legislation affecting insurance regulation, pharmacy audits, reimbursement standards, and consumer protections. The resolution also signals legislative interest in issues already raised in related measures such as spread pricing and rebate pass-through.
The overall sentiment around the resolution appears strongly supportive of PBM reform. The bill’s findings emphasize concerns about high drug costs, reduced access to care, and the harms faced by independent and community pharmacies, and the only recorded vote shows unanimous support in the Senate Health and Human Services Committee, where it passed with amendments 4-0. The discussion reflected in the bill text suggests broad concern about PBM market power and a desire for more transparency and oversight.
The main points of contention are the scope and direction of PBM regulation, especially questions about spread pricing, reimbursement floors, audit practices, and whether PBM-owned pharmacies receive preferential treatment over independent or unaffiliated pharmacies. The resolution highlights competing interests among insurers, PBMs, health plans, and community pharmacies, and it specifically seeks input from both industry and pharmacy stakeholders. The bill text suggests tension over which state agency should regulate PBMs and how aggressively Hawaii should restrict PBM practices to protect consumers and smaller pharmacies.