Mar 5, 2024
Community Pharmacists Call Attention to Increasing Prescription Drug Costs, Decreased Access to Care and Emerging Pharmacy Deserts Correlated to Pharmacy Benefit Manager Practices
SPRINGFIELD, IL (March 5, 2024) – Illinois pharmacists will gather at the State Capitol today to rally in support of HB 4548 and SB 2790, proposed legislation which would eliminate controversial practices by prescription drug middlemen known as pharmacy benefit managers, or PBMs. The rally is scheduled for 1:15 p.m. and will be held near the Lincoln statue, located at the east end of the State Capitol and will include brief remarks by bill sponsors and constituents negatively impacted by PBM prescription drug pricing practices.
If enacted, HB 4548, sponsored by Rep. Jones, would protect patients’ right to receive prescription medication from the pharmacy of their choice, banning the lucrative PBM practice of “steering” patients to PBM-owned or affiliated pharmacies or mandatory mail order. Sen. Koehler’s SB 2790 would empower the state’s Department of Healthcare and Family Services with greater oversight of PBM contracts; monitoring of payments made to PBMs and pharmacies; and ensuring PBM rebates negotiated on behalf of HFS are fully paid to HFS.
“We applaud Representative Jones, Senator Koehler and the many members of our state legislature who are championing these critical measures that would protect the state’s patients and pharmacy providers,” said Illinois Pharmacists Association President Rupesh Manek, RPh, pharmacist and Rochelle-based pharmacy owner. “The proposed legislation is evidence of a responsible governing body aware of the pitfalls that come with overpaying pharmacy benefit managers for services that should be provided in the interest of fiscal responsibility, not overcompensating shareholders.”
Last May, Illinois Auditor General Frank Mautino released the results of a Performance Audit of Pharmacy Benefit Managers, finding the state’s Healthcare and Family Services (HFS) department did not have complete copies of the contracts between managed care organizations and PBMs necessary to conduct monitoring of contract provisions, or between PBMs and pharmacies to be able verify accuracy or rate of reimbursement to pharmacies. The result of passage of SR 792 in 2022, the Performance Audit of the Medicaid Managed Care (MMC) PBMs identified over $200 million over 2 years in spread pricing overbilling to the MMC prescription program.
Anne Cassity, Senior Vice President of Government Affairs for the National Community Pharmacists Association (NCPA) said “NCPA commends the Office of the Auditor General for its diligence in revealing gross overpayment to PBMs in Illinois’ Managed Medicaid program. Sadly, Illinois is joining
numerous other states in recognizing how PBMs harm both the patients and payers – both public and commercial - they purport to serve. We urge Illinois to join the ranks of states who have established comprehensive PBM regulation with strong enforcement provisions to ensure patient access to pharmacy services at their neighborhood community pharmacy.”
PBMs manage patients’ prescription drug benefit, acting as the liaison between the patient, the pharmacy, and the patient’s employer or health plan sponsor. Since 2019, numerous studies have uncovered evidence of PBMs practices that result in endpayers paying significantly more for patients’ prescription medication than the patient’s pharmacy was reimbursed (a practice called “spread pricing”); and patients “steered” away from their pharmacy of choice to PBM-owned/affiliated pharmacies. Additional studies have shown the drug manufacturer rebates PBMs negotiate increase a drug’s list price year over year, causing patients to pay more out of pocket because of rebate-inflated costs. For more information on the rally or how PBM practices are affecting Illinois patients and taxpayers, contact Illinois Pharmacists Association at IPhA.org. Learn more about NCPA, the country’s largest organization of independent pharmacy owners, at NCPA.org. To understand how PBM practices affect patient care and affordability of medication for consumers and end payers, visit PUTT’s website at TruthRx.org.
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