On March 20, Representatives Scott Lipps and Thomas West offered sponsor testimony in the House Government Accountability and Oversight Committee for House Bill (HB) 479, a proposal to regulate pharmacy benefit managers (PBMs) and require disclosure to patients of drug price information.
- Prohibits a health plan or PBM from directing a pharmacy to charge a patient an amount greater than the pharmacy’s cash price or the net reimbursement to the pharmacy. This ensures that regardless of any co-pay gimmicks, the patient will pay the lowest possible amount at the pharmacy counter.
- Prohibits a health plan or PBM from forcing a pharmacist to remain silent when it comes to the financial details and options when it comes to their patients’ medications.
The Ohio Academy of Family Physicians supports HB 479 and has joined the Ohio Prescription Partnership Coalition, a group of nearly 30 organizations that support passage of the legislation that seeks to correct a problem that patients are experiencing when PBMs contractually prohibit pharmacists from disclosing drug prices to the patient. When a patient goes to the pharmacy to pick up a prescription, the cost of the medication may actually be less than the insurance co-pay but the pharmacy’s contract with the PBM may prohibit the pharmacist from informing the patient of that fact. The patient, unless they specifically ask for that information, pays the co-pay not knowing that the prescription cost is less than the co-pay. The PBM keeps the difference between the medication cost and the co-pay as profit. The practice is sometimes referred to as a “claw back.”