The public should know how two prescription drug policies are increasing what patients pay out-of-pocket for prescriptions and taxpayers pay for the state’s Medicaid Program, and what you can do about them.
The first is a “gag order” imposed on every community pharmacist by must-sign contracts with prescription benefit managers (PBMs) that prevent us from telling prescription patients how you can reduce your out-of-pocket expenses for prescriptions.
The typical example of how the gag order clause works is simple.
A pharmacist runs a prescription sale through the system and sees a patient’s copay is $40. But the pharmacist knows if the patient did not use their insurance, the same drug would cost them $18.99, saving them $21.
The gag order clause in the contracts prohibits the pharmacist from telling patients they could save money — even if they ask.
The second issue is the practice where some pharmacy benefit managers (PBMs) in state Medicaid Managed Care Organizations (MCO) are reimbursing community pharmacies for prescription drugs at far below their cost.
At the same time, those PBMs are likely overcharging taxpayers for the same drug by billing the MCO at a higher rate and in some cases reimbursing other, preferred pharmacies, owned by the same parent company as the PBM, at much, much higher rates.
One example from Arkansas had the self-owned, preferred pharmacies reimbursed $400.65 for a pain management drug, while the community pharmacy received $75.74 — an almost $325 difference.
In response to concerns raised by community pharmacists in Pennsylvania, state Auditor General Eugene DePasquale announced he will look into concerns about inequitable pharmacy reimbursement that are artificially increasing prescription costs. Additionally, pharmacists have also asked the Attorney General to look at these issues.
In Pennsylvania, we know PBMs have steadily reduced reimbursements to in many cases, below the cost of drugs over the last year to community pharmacies. But to add insult to injury, a major pharmacy chain is sending out letters to pharmacists offering to buy them out because of “poor business conditions.”
These reimbursement policies are just wrong. Wrong for prescription patients. Wrong for taxpayers. Wrong for your community pharmacies.
Contact your member of the state House and Senate to say you support legislation to prohibit these policies — Senate Bill 1105 and House Bill 2212 on the reimbursement issues and Senate Bill 1110 and House Bill 2211 on the gag order clause.
Your wallet will thank you.