Critical Thinking: Prescription Costs

We have to do something about the costs of prescriptions.

The Pharmacy Benefits Managers (“PBMs”) are the people who administer how your insurance covers the costs of your prescriptions. PMBs are supposed to find savings for you by negotiating in bulk for medications and finding savings through various efficiencies and they do. But they also generate a lot of profit for themselves and the insurance company they work for. They charge administrative fees, get rebates and incentives to choose certain medications. This is a very profitable business. I believe that business should be profitable but not excessively so in a time when the out of pocket costs for a patient are at an all time high. I think the rebates should go to you as the purchaser to keep the cost of healthcare down, and not to a corporate profit margin.

My legislation, SB568, would have ensured that these rebates went directly to patients to lower the costs of prescriptions, and not back into corporate pockets. Last night, my legislation, which had been rolled into another senate bill was killed by the Commerce and Labor committee, it did not pass.

I am frustrated. Last year I was able to get coupon discounts to count toward the patient’s cost. Now, if you use a coupon to get a prescription, the coupon amount and the contribution made by the sponsor of the coupon counts toward your deductible, which saves you the out of pocket cost. In opposition to SB568, the lobbyist for the PBMs and insurance plans argued that passing the rebates through to patients, would increase insurance costs. My burning question is - why does a reduction in the money they are realizing always translate into more costs for the patient instead of a reduction to their profit margin?

I will continue to work to reduce the cost of prescriptions and health care. I have decided to co-patron SB251, which will require licensure of PBMs. This will allow us to begin to monitor and find out where all of this money is actually going.

By licensing the PBMs, we will be in a much better position to answer these questions for ourselves and we can begin to put profits back into the patients’ pockets to lower the costs of prescriptions.

Update 2/4/20

Today this bill passed out of the Senate. An attempt was made to remove a clause that made PBMs give you the lowest price of a prescription instead of the marked up price (called the spread which is the difference between what they pay and what they charge pharmacies)