PBM bill coming before Committee

West Virginia Pharmacists Association’s efforts to resolve issues with the pharmacy benefit management and insurance industry is expected to have some resolution, Friday, February 23, in the House of Delegates Judiciary Committee meeting.

According to Executive Director Richard Stevens, the Committee is expected to take up Senate Bill 46, which was passed the Senate and sent to the House allowing pharmacists to inform their customers about lower cost prescription drugs — an service currently prohibited by many PBMs and insurance companies.    This bill gives an alternative to the patient to reduce their  prescription drug expenditures, and pharmacies can help do that, he said.

“We were successful in getting SB 46 passed by the upper chamber early in this session,” said Stevens.  “The PBMs and insurance companies have come up with a dozen different alternatives and delay tactics over the past three weeks to, in essence, ditch our efforts to pass House Bill 4287 which is intended to prohibit egregious actions by the BPM and insurance industry.    We will have provisions of HB 4287 merged into SB 46, and send it back to the Senate for concurrence.”

The legislation, as drafted, will provide the following major reforms with respect to PBMs:

(1)  A PBM cannot prohibit or penalize a pharmacy or pharmacist in any way for providing information to consumers about lower-cost alternatives or cost-shared in order to assist the consumer in making informed health care decisions;

(2)  A PBM cannot charge a co-pay to an insured individual that would exceed the actual cost of the medication, nor would the PBM be allowed to redact any such adjudicated cost from the pharmacy or pharmacist; and

(3) A PBM will be prohibited from directly or indirectly charging a pharmacist or pharmacy a claims fee that is not apparent at the time of the claim, not revealed or reported on the remittance advice of an adjudicated claims, or that is after the initial claim is adjudicated at the point of sale.