House Bill 479, a bill to prohibit pharmacy benefit managers (PBMs) from issuing gag orders to keep pharmacists from disclosing information about cheaper medications to patients, was introduced on January 24. Bill sponsors Representatives Scott Lipps (R-Franklin, OH) and Thomas West (D-Canton, OH) say the bill, if enacted, will lower prescription drug prices.
The Ohio Academy of Family Physicians, at its board meeting on January 21, voted to support the legislation. The Ohio Pharmacists Association asked that the OAFP support this legislation. They initiated this proposal to correct the practice of PBMs contractually prohibiting 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. This practice is sometimes referred to as a “claw-back” and overinflates the cost or prescriptions.
PBMs operate as a middle-man between insurance companies and the drug companies. Watch the Weekly Family Medicine Update for information on the bill’s progress.