ATLANTA – Drug prices and who controls them could be back before the General Assembly this winter, as consumer advocates and pharmacy benefit managers remain at odds on issues such as drug price transparency.
Governor Brian Kemp last year signed a law tightening the rules on third-party companies that play a role in negotiating drug prices between insurers and local pharmacies in Georgia. The bill signed by Kemp requires companies called Pharmacy Benefit Managers (PBMs) to set drug prices at a national average, a move to curb excessively high prescription prices. PBMs act as intermediaries for prescribers and insurance companies who contract with health insurers to negotiate lower prices for patients. But critics have long accused them of muddling the process, causing drug prices to rise and prescription delays.
Now pharmacies like CVS fear that Georgian lawmakers, when they meet again in January, will take further action on drug prices.
âWe recognize the efforts of some lawmakers to further explore drug price transparency,â said Leanne Gassaway, vice president of state government affairs at CVS Health. âGiven the state enactment of PBM legislation almost every year over the past decade, we would like the legislature to take a close look at the role of drug manufacturers in drug pricing, including a notable lack of transparency in setting and increasing list prices. “
Ryan Hamilton, associate professor at Emory Goizueta Business School, said price transparency usually leads to drug prices falling.
âThe easier it is for customers to get pricing information, the more competitive manufacturers have to be,â he said. “But the prescription drug industry in the United States is so heavily regulated that these general rules may not apply.”
Hamilton said PBMs serve as an interface between drug makers and pharmacies.
“Any move to remove middlemen from the equation will naturally provoke protests,” he said.
Laura Colbert, executive director of Georgians for a Healthy Future, agreed that the issues of drug pricing and transparency, coupled with the role PBMs play in the equation, will return in January.
“Discussions about PBMs have been going on for several years, and the legislature seems quite enthusiastic about continuing this effort,” said Colbert. âBut realistically, it’s hard to know if these savings are actually being passed on. ”
One bill that will be definitively postponed in January is HB 164: Law on Financial Protection of Consumers of Prescription Drugs. This would require health insurers to forward at least 80% of all prescription drug reimbursements to registrants.
âThat 80% is what the Affordable Care Act requires,â Colbert said.
“We have had very fruitful discussions and anticipate a very active legislative session,” said Gassaway, who tackles a difficult public relations challenge: convincing lawmakers and their constituents that making drug prices openly and easily accessible. to the general public will actually lead to higher drug prices.
“If we are only publishing the prices in the public domain, this information will be used to further manipulate the market,” she said. âWe are not opposed to showing our customers how much we save them on drugs. We’re trying to bring that price down, but putting a specific discount in the public domain will only increase the price.
âWe have other great ideas on how to make this information available to patients in a more useful way. “
One of CVS Health’s ideas is to make drug prices available, in real time, to physicians when prescribing drugs. âWe have the ability to make this information available to physicians at their fingertips, in order to determine the best prices,â Gassaway said. “This kind of information – such as cost-sharing alternatives – would be really helpful for patients.”
Gassaway touts CVS member-specific benefit information, which includes plan information, deductibles, and other data that the company says helps healthcare providers and CVS members know if a specific drug is covered as well as the cost of the member.
CVS said Georgia has some of the toughest PBM laws in the country. PBMs are now required to publicly report how much medicine prices for many health plans have been negotiated near a national average. The state also requires PBMs to provide state officials with confidential information about discounts and other negotiating tools.
PBMs are also now required to undergo further audits by the state’s Department of Community Health, as well as requirements for online publication of prescription price data. They are also required to offer full discounts on health plans that are typically given by drug makers, rather than pocketing a portion.