Bills filed to regulate Pharmacy Benefit Managers - WSIL-TV 3 Southern Illinois

Bills filed to regulate Pharmacy Benefit Managers

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WSIL -- A pair of bills filed in Springfield aim to lower prescription drug costs.

Both bills address Pharmacy Benefit Managers and their role in the drug buying process.

What goes into the price you pay for prescriptions at the pharmacy?

Drug companies have to worry about the cost to make drugs and pharmacies have to keep the lights on.

Insurance companies, including state-run Medicaid, usually cover some of the cost of those drugs, and they use Pharmacy Benefit Managers to help.

"Pharmacy Benefit Managers are the middlemen between insurance plans and pharmacies," Ben Calcaterra of the Illinois Pharmacists Association said. "They negotiate contracts to provide reimbursement amounts so that pharmacies are paid for the prescriptions they sell."

He says Pharmacy Benefit Managers, PBMs for short, also negotiate prices with drug companies and sometimes get rebates to lower prices.

Calcaterra said they don't always pass those savings on to other customers.

Currently, there is no regulation of the PBM industry," Calcaterra said. "Which means that they are free to negotiate any price on their behalf, but not share that negotiated rebate with patients or plans or employers that provide the insurance to their employees."

House Bill 465 and Senate Bill 652 aim to regulate PBMs.

Calcaterra said they're largely the same and they tackle a number of things, including reporting requirements for PBMs and a clause that requires pharmacists to tell customers about cheaper forms of their prescriptions.  

Currently, PBMs can write gag orders into their contracts with pharmacists, but these bills would prevent that.

The Pharmaceutical Care Management Association, a lobbying group that represents PBMs, responded to the bills in a statement, saying these bills could actually raise prices by adding unnecessary regulation.  

Tom Wogan, a PR consultant with the PCMA, said the industry is willing to work with lawmakers.

"We want to enter this debate in a very open fashion and in a very cooperative way," Wogan said.

Wogan said the organization also supports gag clauses.

And he said its ultimate goal is also to reduce drug prices.

Both bills were amended this week to add language regulating Pharmacy Benefit Managers.

Neither amendment has been voted on yet in committee.

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