Why SB 45?
SB 45 introduces critical reforms aimed at addressing the detrimental practices of pharmacy benefit managers (PBMs) that directly contribute to raising prescription drug costs for patients in our communities.
The bill imposes a strong dose of transparency and patient protections as well as removing unfair practices that put local independent pharmacies out of business. The FTC has just released their second report in 6 months detailing the PBM’s role in driving up drug costs and not down as they purport to do. Their latest reports details how mark ups are in the thousands of percent for life sustaining medications, badly straining patients and plan sponsors resources.
The bill;
- ensures plan sponsors know "rebate" amounts so they can collect those to offset rising drug prices.
- ensures transparency in PBM contracts, including preventing PBMs from blocking discussions between pharmacies and plan sponsors on health benefits.
- establishes a duty for PBMs to act in the best interest of health plan purchasers, bringing enforceable accountability to their business practices.
- safeguards pharmacies by preventing PBMs from reimbursing them at rates below the pharmacy’s cost to purchase and dispense drugs, while also ensuring PBMs cannot charge health plans or payers a higher price than what the PBM reimburses pharmacies.
- the bill protects patients by precluding health carriers and PBMs from double dipping patient’s pocket on copayments – ensuring payments made by enrollees or on their behalf are counted toward out-of-pocket maximums and cost-sharing requirements, and
- beefs up current law that states a patient’s copayment cannot exceed the cash price of the drug.
Finally, the bill addresses the latest price driver marketing practice by the PBM’s surrounding “specialty drugs”, ensuring that PBM’s ability to pay themselves a self-inflated cost for the drug is greatly diminished. The FTC has focused a great deal on this issue, and has now determined this to be a greater cost driver to patients and plan sponsors than any other revenue stream for the PBM’s. This latest report has really caught the attention of many employers.
We need your help to unravel these long standing PBM business practices so patients can gain access to and afford their medications.
