HB 2224: Department of Human Services; Medicaid; Pharmaceutical Benefits Management; Managed Care Plans

A BILL FOR AN ACT

RELATING TO MEDICAID.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that the State's medicaid program, known as med-QUEST, serves some of Hawaii's most vulnerable residents, including low-income families, kupuna, individuals with disabilities, and those living in rural and neighbor island communities.  The legislature further finds that decisions regarding pharmaceutical benefit management can significantly impact pharmacy reimbursement, patient access, and overall health care expenditures.  Accordingly, it is in the State's best interest to ensure that the department of human services retains the flexibility necessary to evaluate and implement pharmaceutical benefit management structures that best serve medicaid beneficiaries and participating providers.

     The legislature further finds that existing limitations on the department's authority constrain the State's ability to modernize medicaid program administration and adapt to evolving health care delivery and pharmaceutical market conditions.  These constraints hinder the department's ability to consider emerging models that are being adopted and evaluated at both the federal and state levels.

     The purpose of this Act is to restore the department of human services' authority to assess and implement the most effective pharmaceutical benefits management approach for med-QUEST and ensure responsible stewardship of public funds.

     SECTION 2.  Act 4, Special Session Laws of Hawaii 2005, is amended by amending section 3 to read as follows:

     "SECTION 3.  [The department of human services shall not take any action to remove pharmaceutical benefits management from managed care plans that provide health care coverage for Hawaii medicaid beneficiaries.] Repealed."

     SECTION 3.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect on July 1, 3000.

Report Title:

Department of Human Services; Medicaid; Pharmaceutical Benefits Management; Managed Care Plans

Description:

Repeals a provision in Act 4, Special Session Laws of Hawaii 2005, that prohibits the Department of Human Services from taking any action to remove pharmaceutical benefits management from managed care plans that provide health care coverage for Hawaii Medicaid beneficiaries.  Effective 7/1/3000.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

relating to medicaid.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that the State's medicaid program, known as med-QUEST, serves some of Hawaii's most vulnerable residents, including low-income families, kupuna, individuals with disabilities, and those living in rural and neighbor island communities.  The legislature further finds that decisions regarding pharmaceutical benefit management can significantly impact pharmacy reimbursement, patience access, and overall healthcare expenditure.  Accordingly, it is in the State's best interest to ensure that the department of human services retains the flexibility necessary to evaluate and implement pharmaceutical benefit management structures that best serve medicaid beneficiaries and participating providers.

     The legislature further finds that existing limitations on the department's authority constrain the State's ability to modernize medicaid program administration and adapt to evolving health care delivery and pharmaceutical market conditions.  These constraints hinder the department's ability to consider emerging models that are being adopted and evaluated at both the federal and state levels.

     The purpose of this Act is to restore the department of human services' authority to assess and implement the most effective pharmaceutical benefits management approach for med-QUEST and ensure responsible stewardship of public funds.

     SECTION 2.  Act 4, Special Session Laws of Hawaii 2005, is amended by amending section 3 to read as follows:

     "SECTION 3.  [The department of human services shall not take any action to remove pharmaceutical benefits management from managed care plans that provide health care coverage for Hawaii medicaid beneficiaries.] Repealed."

     SECTION 3.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect upon its approval.

Report Title:

Department of Human Services; Medicaid; Pharmaceutical Benefits Management; Managed Care Plans

Description:

Repeals a provision in Act 4, Special Session Laws of Hawaii 2005, that prohibits the Department of Human Services from taking any action to remove pharmaceutical benefits management from managed care plans that provide health care coverage for Hawaii Medicaid beneficiaries.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

STAND. COM. REP. NO.  376-26

Honolulu, Hawaii

                , 2026

RE:   H.B. No. 2224

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2026

State of Hawaii

Madame:

     Your Committee on Human Services & Homelessness, to which was referred H.B. No. 2224 entitled:

"A BILL FOR AN ACT RELATING TO MEDICAID,"

begs leave to report as follows:

     The purpose of this measure is to restore the Department of Human Services' authority to assess and implement the most effective pharmaceutical benefits management approach for Med-Quest and ensure responsible stewardship of public funds.

     Your Committee received testimony in support of this measure from the Department of Human Services; State Health Planning and Development Agency; Hawaiʻi Pharmacists Association; and one individual.

     Your Committee finds that it is in the State's best interest to ensure that the Department of Human Services retains the flexibility necessary to evaluate and implement pharmaceutical benefit management structures that best serve Medicaid beneficiaries and participating providers, as Medicaid spends approximately $350,000,000 on pharmaceutical benefits annually and decisions regarding pharmacy benefit management can significantly impact pharmacy reimbursement, patient access, and health care expenditures.  Your Committee further finds that this measure would provide the Department of Human Services with greater oversight authority over pharmacy benefit management and the flexibility to consider participating in opportunities to leverage improved drug pricing and supplemental rebate opportunities.

     Your Committee has amended this measure by:

     (1)  Changing the effective date to July 1, 3000, to encourage further discussion; and

     (2)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Human Services & Homelessness that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 2224, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 2224, H.D. 1, and be referred to your Committee on Finance.

Respectfully submitted on behalf of the members of the Committee on Human Services & Homelessness,