LEGISLATIVE ROUNDUP: State urges insurers, PBMs to prioritize access to prescription medications

Aug. 8--As Rite Aid stores across Pennsylvania continue to close, the Pennsylvania Insurance Department (PID) this week urged health insurers and pharmacy benefit managers (PBMs) to take immediate steps to protect patients' access to prescription medication as many Pennsylvanians look for a new pharmacy.

"As Rite Aid stores continue closing across the Commonwealth, we are asking insurers and PBMs to do everything they can to ensure Pennsylvanians' prescription access is smoothly transitioned to other pharmacies," said Pennsylvania Insurance Commissioner Michael Humphreys. "We know these closures are stressful, but if insurers, PBMs and pharmacies work together, we can make sure that Pennsylvania families can obtain the care and medications they need without having to deal with unnecessary red tape."

Through Notice 2025-07, posted online, PID reminded insurers and PBMs that network adequacy rules are in place to protect consumers.

Insurers, and in some cases PBMs, are legally required to provide patients with reasonable access to pharmacy services. Any health insurer that is unable to meet the Commonwealth's time or distance standards related to pharmacy access for patients affected by a Rite Aid closure should contact PID immediately.

PID urges insurers and PBMs to:

--Help patients quickly find a new pharmacy if their local Rite Aid has closed.

--Allow a patient to use out-of-network pharmacies when in network pharmacies are not available and make sure patients do not pay more than in-network prices in such cases.

--Transfer any existing approvals or prior authorizations to the new pharmacy automatically--patients should not have to reapply.

--Set up hotlines, websites, or other support tools to make prescription transfers easy.

--Fast-track urgent requests, like specialty medications and controlled substances.

--Pause or reschedule pharmacy audits, so local pharmacies can focus on helping more patients during this busy time.

Pennsylvanians who had their Rite Aid pharmacy close should contact their insurance company first. However, if consumers do not receive a response or have issues accessing their prescriptions, they are encouraged to visit pa.gov/consumer, or call 1-866-PA-COMPLAINT.

AG launches 'Operation Robocall Roundup'

Attorney General Dave Sunday this week announced the first action under "Operation Robocall Roundup" -- a multi-state effort by the Anti-Robocall Litigation Task Force to crack down on robocalls across Pennsylvania and nationwide.

Sunday joined 50 bipartisan Attorneys General in sending warning letters to 37 voice providers demanding that they immediately stop illegal robocalls being routed through their networks.

"Robocalls are not just an annoyance, many of them are illegal," Sunday said. "Robocalls are often a tool used by scammers to take advantage of the most vulnerable Pennsylvanians. Illegal robocalls will not be tolerated in the Commonwealth, and I am proud to stand with my colleagues to announce action that we expect will result in federal investigations, and, ultimately, fewer of these calls."

Consumers can sign up to be on the Pennsylvania Do Not Call list at www. attorneygeneral.gov/dnc, or by calling 1-888-777-3406.

The providers receiving the warning letters have not complied with Federal Communications Commission (FCC) rules about responding to government trace-back requests, haven't registered in the FCC's Robocall Mitigation Databases, or haven't filed a plan that describes how they will reduce illegal robocalls on their telecom network.

By disregarding these simple rules, these companies are allowing robocallers onto their phone networks and then passing those robocalls downstream to other providers until robocalls reach the phones of Pennsylvanians. The task force is also sending warning letters to 99 downstream telecom providers.

The FCC is also taking a close look at many of these companies. It recently announced that it will be removing seven of these following telecom providers from Robocall Mitigation Database, which means that other providers will no longer be allowed to accept and route any calls from the removed networks.

Consumers can use the following tips to avoid unwanted calls:

--Be mindful of providing your phone number to businesses asking for your telephone number. Signing up for a rewards program or similar with your phone number allows the business to place you on telemarketing lists without requiring further consent.

--Be aware of providing contact information when participating in online surveys of contests. Read the fine print -- you may be adding yourself to a telemarketing list.

--Entering contests at fairs and other public events may lead to future telephone solicitations.

Department of Aging receives national praise

Following the Pennsylvania Department of Aging launch of the PA CareKit in May -- a resource to support the Commonwealth's unpaid caregivers including spouses, adult children, and grandparents raising grandchildren -- national organizations that advocate for older adults, their caregivers and families are praising the Department's "personalized" and "easy-to-use" resource.

The PA CareKit provides training, connection to respite services and personalized tools to help informal caregivers address their unique situations.

The National Alliance for Caregiving, the National Academy for State Health Policy, and ADvancing States are praising the PA CareKit, which offers an array of personalized and tailored resource guides, and resources for families to evaluate and select professional caregivers. Print materials from the PA CareKit will be available for free at community libraries, the 52 Area Agencies on Aging, and Senior Community Centers across the Commonwealth -- and an electronic version is available on the Department's website.

"Caregiving is important work that can be deeply rewarding, but it also presents significant challenges for caregivers' personal well-being," said Secretary of Aging Jason Kavulich. "Better resources for our caregivers mean safer homes for our loved ones."

The Department of Aging recently presented the PA CareKit to a national audience of aging and disability experts, policymakers and advocacy groups. Multiple organizations have highlighted the PA CareKit's potential to benefit older adults in other states.

Experts have lauded the PA CareKit, saying it stands out as a national model by:

--Giving caregivers a clear starting point when they don't know where to begin;

--Supporting all types of caregivers, including spouses, adult children, and grandparents raising grandchildren;

--Offering customized guidance based on each caregiver's role and needs; and

--Reflecting real-life caregiving challenges because it was built with input from caregivers and experts.

The development of the PA CareKit was a top aging services priority in Governor Josh Shapiro's 2024-25 budget and is the result of year one of implementing Aging Our Way, PA -- a 10-year plan to improve the infrastructure of aging services.

Senior expo for 117th district residents set

Rep. Jamie Walsh, R-Ross Township, invites residents of the 117th District to a free Senior Expo from 10 a.m. to 1 p.m. Tuesday, Aug. 12, at Misericordia University's Insalaco Hall, 301 Lake St., Dallas.

The expo will feature more than 30 vendors offering information and services for seniors. Several breakout sessions will be held on topics like estate planning, Area Agency on Aging programs, Silver Sneakers chair yoga, low-income taxpayer assistance information, cyber security and fraud bingo.

The Pennsylvania Treasury Department will also be in attendance to help search for unclaimed property.

Free hearing tests and light refreshments will be available.

For information, call Walsh's Dallas office at 570-675-6000.

Reach Bill O'Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.

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