Ohio House bill aligns drug prices with cost

The Feb. 27 Dispatch editorial “Time to rein in US drug prices” reviewed how some large corporations and hospitals are considering steps they can take to rein in drug prices.

There is no single solution to lower prices and ensuring patients have access to the medications they need. Still we need to consider all options that could make an impact. Any thorough discussion on escalating costs of medication must include the role of pharmacy benefit managers.

In our drug supply chain, PBMs operate with little to no transparency. It’s recently come to light PBM practices actually increase costs for consumers and prohibit pharmacists from disclosing pricing options to their customers. We are fighting this in Ohio through House Bill 479, introduced by Reps. Scott Lipps, R-Franklin, and Thomas West, D-Canton.

H.B. 479 seeks to reform PBM practices where a patient’s copay amount is higher than what the PBM is paying for the drug or in situations where the patient would pay less out of pocket by not using his or her insurance coverage. The PBM now not only keeps that difference, but also requires pharmacies to enter into contracts that place gag orders on pharmacists, making them unable to provide cost options to customers. Pharmacists should be able to advise patients on the lowest cost option, without being at risk of losing the PBM contract and all the customers that come with it.

Passage of Ohio H.B. 479 would benefit the more than 20,000 Ohioans living with multiple sclerosis. To live their best lives possible, people with MS must follow a consistent course of disease-modifying therapies. Today the median price of MS disease-modifying therapies is nearly $80,500 a year. Currently there are more than a dozen therapies available. Even the generics (all for the same brand product Copaxone) are between $63,000 and $65,000.

While people living with MS typically do not pay the full amount, there are many cases of people who stop treatment because of high out-of-pocket costs and even more cases of nonadherence. People with MS also take a number of symptommanagement medications that are affected by PBM practices, and every bit of savings helps when living with a complex, lifelong and expensive condition like MS.

MS patients are not the only ones hard-hit by increasing out-of-pocket expenses and puzzling formularies. Other advocates working for passage of H.B. 479 include groups that represent people with cancer, heart disease, mental illness, Crohn’s and Colitis disease, arthritis, diabetes and more. When consumers go to the pharmacy, no matter their condition, they want to know they are paying the actual price of their medication — not an inflated price — and they want to be able to trust their pharmacists to tell them the best savings option.

H.B. 479 will prohibit a health plan or PBM from directing a pharmacy to charge a patient an amount greater than the pharmacy’s cash price or the net reimbursement to the pharmacy. This ensures that regardless of any copay gimmicks, the patient will pay the lowest possible amount at the pharmacy counter. In addition, the bill will prohibit a health plan or PBM from forcing a pharmacist to remain silent about price options for the customer.

Medications must be affordable, and the process for getting them simple and transparent. H.B. 479 offers two common-sense provisions that will lower costs for patients and allow pharmacists to be transparent with customers on critical pricing information. Ohio lawmakers have an opportunity to address drug prices right now. This proposed law offers a needed check and balance on the role of PBMs in the drug supply chain.