A bill under consideration by the Arizona House of Representatives would save the state’s consumers considerable money and headache-inducing frustration. HB2107 would disallow a secret – but contractually mandated – practice by pharmacy benefit manager companies (PBMs) that forces pharmacies to remain silent when patients’ prescribed medication could be purchased for less than their insurance co-pay. Removal of the contract’s “gag clause” would allow pharmacists to inform their patients of money-saving options, without fear of retaliation from PBMs.
Under the current system, PBMs – the unregulated, invisible “middlemen” who manage the prescription drug benefit of an individual’s health insurance plan – are allowed to engage in practices that ultimately harm consumers and drive up drug prices.
Questionable PBM practices include:
- Negotiating proprietary pricing and rebates with pharmaceutical manufacturers on behalf of the health insurance company or “payer” (in the case of self-insured companies), and then withholding details of this “proprietary pricing” from payers while keeping some or all of the rebates;
- “Clawbacks – PBMs often inflate the patient copay and recoup or take back the difference, leaving patients to pay more than the price of the drug; and
- Prohibiting pharmacies from dispensing a 90-day supply while allowing their own or their “preferred” pharmacies – usually mail order – to dispense 90-day supplies and provide discounts or other financial incentives to patients for choosing the PBM preferred/mail order pharmacies over an independent or neighborhood pharmacy.
If HB2107 is enacted, these practices would be illegal, restoring the right of free and open dialog to patients and their pharmacists. The legislation would also help level the playing field for Arizona’s independent and community pharmacies, a field that is currently deeply pitched in favor of the multi-billion dollar PBM industry. Small business pharmacies, like all small businesses, create jobs, pay taxes and fuel the economy. As such, they need the state’s support to operate, especially when the multi-billion dollar competition engages in anti-competitive activity.
Even if consumers can’t choose their medications, they should have the right to know if there are money-saving alternatives to using their insurance, and the right to choose where and from whom they will buy their prescriptions.
Monique Whitney is the communications director for Pharmacists United for Truth and Transparency.
The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.