Practices by at least one PBM are currently under investigation by the Auditor General.
“PBMs hired by employers, unions and health care plans to manage prescription drug benefit plans are supposed to be negotiating with drug makers and setting fair reimbursement rates – they’re supposed to be working to lower drug costs,” said Rep. Matzie, who is co-chairman of the state Community Pharmacy Caucus. “Instead, what we’re finding is that some of them are reimbursing pharmacies for way below their dispensing costs, up-charging the insurance plans and keeping the profit.
“What you have is a largely unregulated middleman that can do a tremendous amount of harm. Unfair practices by PBMs can cost taxpayers millions, drive up the cost of healthcare, and force mom-and-pop pharmacies out of business.”
Rep. Matzie said the hearing featured testimony by independent pharmacists, who explained how they are being squeezed out of the business by unfair PBM practices. He said he believes the ongoing investigation is a positive first step.
“We have entrusted these companies with an enormous responsibility and an enormous amount of taxpayer dollars – $3.4 billion in 2017 alone. Yet we hear time and again that they are not meeting, and at worst are abusing, this responsibility. It’s time to further investigate this situation, and time for legislative oversight,” said Rep. Matzie.
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