After running out of time to advance House Bill (HB) 479 in the 132nd General Assembly, legislation to reform the pharmacy benefit manager (PBM) system has been reintroduced for the consideration of the 133rd Ohio General Assembly. The House passed the legislation unanimously last year, but after receiving an initial hearing in December 2018, it failed to clear the Senate before the two-year session ended December 31, 2018.
Representatives Scott Lipps, R-Franklin, OH, and Thomas E. West, D-Canton, OH, have reintroduced legislation aimed at lowering prescription drug costs by increasing price transparency for both consumers and pharmacists. The bill has not yet been assigned a bill number. Senator Tina Maharath introduced companion legislation in the Senate (SB 14).
The bill seeks to reduce the administrative burden placed on pharmacists by PBMs, which act as third-party intermediaries between pharmacies and health insurers. By requiring that patients are informed of the most affordable payment option for their prescriptions, PBMs will be unable to direct the pharmacy to charge the patient more than the cash price of a drug. By inflating this cost to patients, PBMs take a portion of the patient’s co-pay, driving up costs.
The bill also prohibits PBMs from including a provision in their contract with a pharmacy that forbids pharmacists from informing patients of the cheapest method to purchase their prescriptions. For example, if a copayment is more than the price of a drug without insurance, the pharmacist must inform the patient. The patient may then decide to pay less for their prescription without going through their insurance.
Both bills seek to make permanent in state law the regulations imposed on PBMs last year by the Ohio Department of Insurance.
The OAFP supports the Prescription Drug Co-Pay Integrity Act.