On April 10, the House Government Accountability and Oversight Committee heard 10 witnesses testify in favor of House Bill (HB) 479, a bill to require that pharmacy customers be told about and receive the cash price for medicine whenever it’s cheaper than an insurance co-payment. The Ohio Academy of Family Physicians strongly supports this legislation.
Ohio pharmacists have said that their contracts with pharmacy benefit managers (PBMs) in some cases include clauses that prohibit them from telling customers that the cash price for drugs is cheaper than their co-payments.
On April 4, the Ohio Department of Insurance ordered the PBMs to stop enforcing any gag rules. Supporters of the legislation say that even with the Ohio Department of Insurance directive, passage of the legislation is necessary to prevent future PBM claw back activity.
- 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.
Pharmacy benefit managers say they negotiate better prices from drug makers and pharmacies than customers would otherwise receive.