Column: Creating Fairness in Prescription Drug Costs | Oklahoma

I will introduce a bill in committee next week that could reduce the cost of prescription drugs for many Oklahomans.

House Bill 4087, the Oklahoma Rebate Pass-Through and the PBM Meaningful Transparency Act of 2022, would create fairness and ensure patients get point-of-sale manufacturer rebates on prescription drugs. Many drug reimbursements never reach the patient and are swallowed up by pharmaceutical intermediaries such as Pharmacy Benefit Managers (PBMs) and/or insurance companies. They simply pocket the reimbursement intended to lower your drug costs, resulting in higher prices at the pharmacy.

The bill would require Pharmacy Benefit Managers (PBMs) to provide the Oklahoma Department of Insurance with prior calendar year reports containing information about the pharmacy benefits provided by health insurers to enrollees in the state and some cost information. The Department of Insurance would then be required to publish the information on its website for public transparency. The measure specifies penalties for violations of the law.

The problem is that many patients with commercial health insurance pay high fees for most of the prescription drugs they take. It’s a burden for many Oklahomans, especially those on limited incomes. Some even have to choose each month to pay for their medicine or food. Insurance companies and PBMs, meanwhile, often get steep discounts – on average around 40% – from branded pharmaceutical manufacturers. In Oklahoma in 2020, these rebates and other rebates totaled $187 million.

Unfortunately, these cost reductions are not always passed on to the consumer. Instead, patients often pay more due to the price of increased insurance deductibles, coinsurance, or plans that require a patient to pay the full drug price before coverage takes effect. Additionally, patient copayments or deductibles are often based on the undiscounted price. of drugs, even when insurance companies and PBMs pay a reduced amount negotiated with a drug manufacturer. Thus, patients pay more than insurance companies or PBMs for the same drugs.

Here is an example. Suppose a prescription drug costs $100, but the insurance company and PBM have negotiated a 40% discount, so the drug costs them $60. The patient is still billed $100 for the drug. Even though the patient only has to pay a percentage of the cost through a co-payment, they still pay based on the full drug price, not the discounted amount actually paid. In this scenario, if the co-payment is 25%, the patient pays $25, not $15, for example. This is unfair and this bill would force PBMs and insurance companies to give you these refunds.

HB4087 would require health insurers and PBMs to disclose their discounts and share at least a portion of the cost savings they negotiate with patients over the counter at the pharmacy. Some worry that this will increase insurance premiums, but some actuarial studies show that savings on drugs would offset any small increase in premiums.

This bill will create fairness for the people of Oklahom.

Please feel free to contact me at [email protected] or (405) 557-7327.

God protects you! Mark

About Terry Gongora

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