An update over how states are taking on PBM's:
In Ohio and across the nation, lawmakers are pushing for more transparency in prescription drug pricing over concern that PBMs drive up costs and limit patients’ access to medications.
State Medicaid officials are investigating allegations that PBMs in the tax-funded health insurance program are paying pharmacies far less to fill some prescriptions than they charge the state and pocketing the difference, a practice known as spread pricing.
House Bill 479 -- Tighter rules on pharmacy-benefit managers
Pharmacy-benefit managers, or PBMs, are third-party middlemen who negotiate drug prices with manufacturers and payments to pharmacies. HB 479, which has bipartisan support, would limit what PBMs could charge consumers and ban them from imposing "gag orders" that prevent pharmacists from telling customers about cheaper ways to get medications. A House committee voted unanimously on Tuesday to wave the bill ahead for a House floor vote.
Here's a list of what it would do:
1. The bill would prohibit health insurers and PBMs from charging consumers co-pays amounting to more than they would pay if the drugs were purchased without insurance or more than the pharmacy was being reimbursed to fill a prescription.
2. It would ban “gag rules” that prevent pharmacists from telling their customers about cheaper options for acquiring medications, such as paying out of pocket.
3. The bill also would outlaw PBMs from retroactively reducing reimbursements paid to pharmacists except because of technical error. The practice, known as clawback, can cause pharmacists to be paid less than their cost to acquire a drug.
House committee OKs crackdown on pharmacy-benefit managers
In Ohio and across the nation, lawmakers are pushing for more transparency in prescription drug pricing over concern that PBMs drive up costs and limit patients’ access to medications.
State Medicaid officials are investigating allegations that PBMs in the tax-funded health insurance program are paying pharmacies far less to fill some prescriptions than they charge the state and pocketing the difference, a practice known as spread pricing.
House Bill 479 -- Tighter rules on pharmacy-benefit managers
Pharmacy-benefit managers, or PBMs, are third-party middlemen who negotiate drug prices with manufacturers and payments to pharmacies. HB 479, which has bipartisan support, would limit what PBMs could charge consumers and ban them from imposing "gag orders" that prevent pharmacists from telling customers about cheaper ways to get medications. A House committee voted unanimously on Tuesday to wave the bill ahead for a House floor vote.
Here's a list of what it would do:
1. The bill would prohibit health insurers and PBMs from charging consumers co-pays amounting to more than they would pay if the drugs were purchased without insurance or more than the pharmacy was being reimbursed to fill a prescription.
2. It would ban “gag rules” that prevent pharmacists from telling their customers about cheaper options for acquiring medications, such as paying out of pocket.
3. The bill also would outlaw PBMs from retroactively reducing reimbursements paid to pharmacists except because of technical error. The practice, known as clawback, can cause pharmacists to be paid less than their cost to acquire a drug.
House committee OKs crackdown on pharmacy-benefit managers
