FRANKFORT-Legislation that would limit how much pharmacy benefit managers can claim
from customer prescription drug payments has cleared a House committee.
Pharmacy benefit managers, or PBMs, are entities that work with private insurers and
programs like Medicaid to provide prescription drug benefits and process claims. Yet
according to independent pharmacy owner Rosemary Smith, many PBMs are taking more
than they should.
Smith, a co-owner of Jordan Drug pharmacies in Eastern Kentucky and founding member
of KIPA (Kentucky Independent Pharmacist Alliance), said PBMs “clawback” part of a
customer copay on drugs while prohibiting pharmacies from telling customers they can
make what could be a less-costly cash payment instead.
“Because of PBM contracts, our pharmacists are not currently allowed to tell
customers the cheapest way they can purchase their medication,” Smith told the House
Banking and Insurance Committee.
Smith was before the committee to testify in support of Rep. Michael Meredith’s
House Bill 463, which would prohibit PBMs from requiring drug payments in excess of
required amounts, imposing penalties on pharmacies for complying with the proposal,
or stopping a pharmacy from sharing information on more affordable cost options with
consumers.
“What the bill does is it says when you come in to a pharmacy, the cost of a drug –
the copay-can’t be higher than what the cash price would be,” Meredith told the
committee, which voted unanimously to approve the bill.
Smith said her pharmacies and other independent pharmacies have personal
relationships with many of their customers, most of whom have been customers for
decades. The pharmacies want to be honest with those customers, she said.
“It is truly heartbreaking for us in the pharmacy community to know this goes on
when our lips are sealed,” she told the committee.
Meredith said PBMs have agreed to the language in the bill, which he added has had
input from many stakeholders in the issue.
“This bill is good for consumers in Kentucky. This bill is good for independent
pharmacists and pharmacies in Kentucky,” he said.
HB 463 now goes to the full House for consideration.