A committee led by Sen. Dick Durbin, D-Ill., held a meeting this week in Chicago to discuss efforts to reduce prescription drug prices. [Health News Illinois]
They focused on the role of pharmacy benefit managers in the prescription drug pipeline, a discussion that echoed hearings Illinois lawmakers have been having this year.
Illinois Attorney General Kwame Raoul called for more transparency on PBM pricing and business practices. While discussions are ongoing in Springfield, he told the committee that Congress must lead on the issue.
“The question that we're faced with with state actions to regulate PBMs is whether we're preempted by the feds, and that's why we've been trying to use both efforts to encourage and protect state efforts to to control the pricing, as well as to encourage Congress to be able to get some transparency and get these PBMs to furnish their pricing data to that as well as state payers,” Raoul said.
Raoul this summer requested the U.S. Supreme Court review how much authority states have to regulate the industry. In response, the Pharmaceutical Care Management Association, a trade group for PBMs, said that requiring plan sponsors to include “unsafe or inefficient pharmacies in their provider networks, and forbidding health plans from using common cost-containment tools like preferred networks, will increase prescription drug costs for plans and patients.”
PBM leaders have told state lawmakers that they are not opposed to more transparency, but stressed that if some information is made public regarding negotiations with drug manufacturers or pharmacies, it could affect their ability to achieve lower prices.
The committee also discussed the role of advertisements to direct consumers to request certain medications from their doctors, regardless of whether it is necessary or if there’s a cheaper generic.
Dr. Anthony Douglas II, a general surgery resident at the University of Chicago, said it’s common for patients to request a drug like Ozempic, only to find out they cannot afford the list price.
“Not only do they advertise directly to physicians to encourage us to prescribe these medications, but they also encourage patients to go in the clinics, in the hospitals, to ask for these medications,” Douglas said.
Durbin has long advocated for legislation to require drug manufacturers to provide price disclosures on advertisements for prescription drugs. Manufacturers have opposed the previous efforts, saying they could confuse patients and may discourage some from seeking needed care.
Durbin proposed another plan in September that would task the Food and Drug Administration to address false and misleading prescription drug promotions by social media influencers and telehealth companies.
At the meeting, Durbin promoted the Biden administration’s efforts on Medicare price negotiations, which he said aided more than 280,000 Illinoisans who take one or more of the 10 drugs affected by the policy.
Pharmaceutical Research and Manufacturers of America CEO Steve Ubl said earlier this summer there are no assurances patients will see lower-out-of-pocket costs as the law that allowed for negotiations did “nothing to rein in abuses” by the insurers and PBMs that decide what medicines are covered and what patients pay.
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