December 19, 2019
Rep. Jackie Toledo filed legislation Tuesday to crack down on what she describes as over-charges on prescription medication caused by predatory practices among Pharmacy Benefit Managers, or PBMs.”
Those are pharmacy middlemen established to facilitate claims approval for medications that require authorization in real-time.
The bill (HB 961) addresses the pricing disparity between how much PBMs charge insurance providers compared to how much they reimburse pharmacies, paying self-owned pharmacies more than other pharmacies or steering patients to pharmacies they own and PBMs not passing along savings from third-party rebates.
The bill would also increase transparency by requiring all information, including PBM revenue, to be reported to the state.
PBMs in violation of the proposed law would be subject to $10,000 in civil penalties and could have their certifications revoked by the state. Continue Reading