With just an hour left in the regular session, the ¶¶Ņõh Senate on Thursday killed a that would have barred companies from owning both and pharmacies.
That decision defied Gov. Jeff Landry, who said he would call the legislature back in for a special session to address the PBM issue.
āYes we will have a special to lower prescription drugs for our citizens. It's that important!" Landry said in a statement through a spokesperson.
It was not clear when Landry might issue that call.
Senate President Cameron Henry, R-Metairie, said senators had concerns about the rapid pace at which House Bill 358 was being considered ā it only emerged from a conference committee with the language addressing PBMs Wednesday afternoon.
āThereās a legislative process for a reason,ā Henry said. āThat amendment did not have one ounce of public testimony through the process.ā
Henry pointed out that the bill would not have taken effect until 2027 anyway, had it passed, which meant the Legislature could simply vote on the bill next year.
āI donāt know why you would call a special session for a bill that doesnāt take effect until 2027,ā Henry said.
What the bills do
Rather than approve the governorās preferred policy change, the Senate passed a last-minute resolution asking for a study on the impact of prohibiting PBM ownership of pharmacies, a practice known as āvertical integration.ā
And the Legislature passed a bill that would set new rules for how those companies can operate, requiring them to pass more of their savings on prescription drugs to consumers and barring them from requiring customers to use their drug stores.
The series of political maneuvers and votes came after a ferocious, last-minute lobbying battle between some of the countryās largest PBMs āincluding CVS, which sent a to customers urging opposition to the bill ā and Landry, who publicly pressured legislators to restrict the PBM giants.
HB358 would have banned companies from owning both pharmacy benefit managers and pharmacies. Supporters argue doing so would stop big companies from pushing out independent pharmacies.
PBMs act as middlemen between pharmacies, health care plans and drug manufacturers to negotiate lower drug costs, but critics say they have too much power over the drug market, drive out competition and limit where people can get their prescriptions filled.
CVS, which owns both a PBM and a nationwide chain of drug stores, said the bill would have forced it to close its 119 stores in ¶¶Ņõh, affecting about 1 million patients across the state and 22,000 patients who receive high-cost specialty drugs that smaller pharmacies could find difficult to handle.
āOur focus remains on serving the people of ¶¶Ņõh: lowering drug costs, providing access to care, and helping improve health,ā said CVS spokesperson Amy Thibault after the Legislature adjourned. āWe look forward to working productively with policymakers to continue to make prescription drugs more affordable and accessible and promoting the value of community pharmacy.ā
In the hours before the sessionās 6 p.m. deadline, Landry and other PBM critics took to social media to pressure legislators.
Landry, who for days had been publicly urging the Legislature to pass the PBM-pharmacy prohibition, said in a post on X hours before the end of the session that he could quickly call lawmakers back into a special session should they reject the measure.
Donald Trump Jr., the presidentās son, weighed in on the PBM political battle 20 minutes later with a post on X: ā¶¶Ņõh, itās time to pass HB358 and end the charade that costs hard-working Americans so much money when buying prescription drugs.ā
The House on Wednesday approved the bill on an 88-4 vote. But the Senate did not bring it up for a vote Thursday.
Instead, its members passed without opposition a resolution, SR 209 sponsored by Sen. Kirk Talbot, R-River Ridge, asking the ¶¶Ņõh Department of Health to study the idea of implementing the rules sought in HB358.
The House ultimately unanimously approved House Bill 264 by Rep. Michael Echols, R-Monroe, which establishes new rules for PBMs. In addition to requiring more money go to customers, the bill requires PBMs to disclose more information to the state.
On the House floor, Echols said HB264 includes āstronger oversight tools,ā protects consumers, enhances transparency and addresses āheinous practicesā by PBMs.
"Today is a giant leap forward, and we keep our promise to you to fix these problems." Echols said. "We're not done. I think we're just beginning, but this opens a big door for us to go through."
Talbot said HB264 was a sign that āthe big pharmacies are on notice now.ā And he said the Senate may be open in the future to banning vertical integration.
āIt aināt over,ā Talbot said.
Text messages draw ire of state leaders
CVSās decision to send text message blasts urging customers to oppose HB358 infuriated state leaders.
¶¶Ņõh Attorney General Liz Murrill announced Thursday she would issue a cease-and-desist demand letter over the texts.
She also announced an investigation into CVS over the text messages, saying that using patient contact information for lobbying may not be āan appropriate use of personal information obtained through a state contract.ā
Caremark, which is part of the CVS family of companies, is a PBM for the state government.
Gov. Jeff Landry slammed CVS on social media saying, āAbusing patientsā sensitive information to push a political message is completely unethical and manipulative and we will not stand for it.ā
Thibault, the CVS spokesperson, said in a statement the company's communications with its customers, patients and community members were "consistent with the law."
"We believe we have a responsibility to inform our customers of misguided legislation that seeks to shutter their trusted pharmacy, and we acted accordingly," she said.
Echols said the legislature could not be bullied, because it always sides with ¶¶Ņõhns.
Controversy as the clock ran out
Debate over HB 358 exploded in the last two days of the session.
The bill was originally designed to allow pharmacy technicians to access pharmacy records and systems remotely. But on Wednesday afternoon, it emerged from a conference committee ā where lawmakers from each chamber meet behind closed doors to work through disagreements ā to add the provision about pharmacy and PBM ownership.
CVS hads blasted that process, saying the state was making a major change to pharmacy laws at the last minute with no public hearings.
Supporters argued the restriction on PBMs would stop big corporations from having an unfair advantage that has led to the closure of independent pharmacies.
Independent pharmacies have been getting reimbursed less and less every year ābecause the PBMs want to make their own pockets fatter,ā Rep. Dustin Miller, D-Opelousas, who is sponsoring HB 358, said on the House floor Wednesday.
āI think itās time that we tell PBMs you have to choose: Youāre either a PBM or youāre a pharmacy in ¶¶Ņõh,ā Miller said.
Lawmakers in favor the change said they werenāt forcing any pharmacies to close.
But Thibault said, āItās not possible to operate a PBM in all states but one.ā
āPBMs serve employers with people in multiple states. You canāt have a state-by-state PBM, so we donāt have a choice,ā she said.
Arkansas passed a similar earlier this year. CVS has filed a lawsuit seeking to block it from taking effect.
Patients react to CVS campaign
On Thursday, a steady trickle of customers picked up prescriptions as usual at stores on Magazine Street and Prytania Street.
After a morning of doctorsā appointments, Cynthia Marshall, 72, stopped to pick up a prescription after seeing a text message from CVS. She hadnāt had a chance to learn more about the bill, but said there were alternatives if the store did close.
āWe would probably just go to Walgreens,ā said Marshall.
But Marshall said Walgreens is small, and she was concerned about it taking on the patient load of closed stores.
Along with the text campaign, CVS stores across Louisian hung colorful āSave our Storeā posters at their entrances, and some locations even passed out flyers to customers.
Jordan Hefler, of Baton Rouge, stopped at a CVS store Wednesday and said the cashier handed her a āSave our Storeā flyer containing a QR code. The employee urged her to sign a petition.
Hefler was initially confused and worried about CVS stores closing. But she said she looked into the issue and realized it was more ācomplicatedā and āprobably not as immediate as it was made to sound.ā
Some CVS patrons said they had not heard of the news, and werenāt too worried about it.
Allen Hall, of Watson, uses the pharmacy at the Denham Springs CVS and said Thursday he had not received any texts from CVS or heard about possible closures.
āIf they shut down, Iāll just go somewhere else,ā Hall said.Ā