Attorney General Anne Lopez filed a lawsuit on behalf of the State of Hawaii against CVS Caremark, Express Scripts, and OptumRx, the largest PBMs who serve hundreds of thousands of Hawaii residents. The partially redacted complaint alleges that PBMs deceptively represent that they lower drug costs. The complaint alleges that PBM business practices are responsible for increasing the cost of brand name drugs by inflating Wholesale Acquisition Cost and then seeking higher fees. It also outlines that PBM rebate schemes narrow patient care options, citing how the number of medications excluded from Hawaii formularies increased by 961 percent between 2014 and 2022. The state is seeking damages, civil penalties of up to $10,000 per violation, additional civil penalties of up to $10,000 for each deceptive or unfair act that was directed towards a senior, punitive damages, and disgorgement of profits.

Hawaii legislators are considering a new bill, HB 1221, that recognizes pharmacists as providers and mandates reimbursement for services rendered within their scope of practice. There are significant cost savings and improved health outcomes associated with pharmacists receiving optimal reimbursement rates. HB 1221 now awaits hearings in the House of Representatives.

Alongside leadership from the Hawaii Pharmacists Association, NCPA participated in a meeting with Insurance Commissioner Gordon Ito to discuss PBM oversight and enforcement. As originally introduced, HB 1381 removed certain reimbursement protections from the Department of Health but did not propose a transition to the Office of the Insurance Commissioner as in previous years. In recognition that PBM oversight is needed, and in response to advocacy efforts, SB 1381 was amended to include a delayed implementation date of 2050.

The state of Hawaii recently heard testimony on SB 605, "Relating to PrescriptionDrugs." This bill would require prescription drug manufacturers to notify drug plans and PBMs if a proposed increase in wholesale drug prices would result in a 16% or more price increase in a  two-year period. The Senate Health Committee deferred SB 605 to a future hearing.