pay no more than is absolutely necessary for
IT'S TIME TO MAKE THE PBM SYSTEM WORK FOR OHIO TAXPAYERS AND CONSUMERS.
IT'S TIME FOR THE
PBM ACCOUNTABILITY PROJECT.
While the pace of medical innovation has yielded unprecedented advances in how we treat – and even cure – many serious diseases, the price and actual costs of prescription medicines for patients and purchasers have remained largely a mystery.
The PBM Accountability Project of Ohio brings together leaders across the state to help ensure that Ohioans aren’t overpaying for the prescription medicines they need. We are working to improve the understanding of the Pharmacy Benefit Managers' — or “PBMs” — process for determining the cost of medicines, and find solutions to help redirect savings to patients, employee health plans, and state taxpayers.
PBMs have asserted that they were created to increase the bargaining power of patients and purchasers in negotiating prices for prescription medicines. However, recent investigations by local journalists and audits by state officials have revealed that PBMs have been the ones profiting at the expense of Ohioans. Today, as controversy over PBM pricing schemes swells and litigation against PBM pricing practices continues in our state, we believe that the time for meaningful reform has come.
The mission of the PBM Accountability Project of Ohio is to assure that the prescription drug savings PBMs capture are actually passed through to Ohioans who need and deserve them, rather than being diverted into excessive profits of PBMs.
We are committed to finding meaningful reforms in the drug pricing system to minimize waste and to ensure Ohio patients, families, and communities can afford their medications.
Together, we are:
providing resources to educate stakeholders
effecting change for the benefit of Ohio patients, taxpayers, public and private sector purchasers of prescription medicines
Together, we believe:
PBMs should compete transparently
The lion's share of financial savings should flow directly to Ohio patients, health plan beneficiaries, and taxpayers.
PBMs should be accountable for delivering the highest possible savings - the most affordable prescription drug pricing - to Ohio group purchasers and individual patients.
PRESCRIPTION DRUG PRICING AND PBMs
The debate over prescription drug pricing is ongoing. We know that out-of-pocket drug costs are rising, but we don’t really understand why or how. The price and actual costs of prescription medicines have remained largely a mystery. The opacity and complexity of the drug pricing system undermines the possibility for PBM competition based on price that would drive value and savings to Ohio purchasers and patients; instead, the absence of transparent, price-based competition provides opportunities for PBM middlemen or to reap excess profits at their expense...
Savings Should Be Directed to Ohio Patients & Taxpayers:
The PBM system was adopted to help determine affordable prices for prescription medicines and ensure that patients have affordable access through insurance plans. Savings negotiated by PBMs with drug manufacturers should be flowing to reduce taxpayers’ and patients’ costs of prescription drug programs. PBMs are setting patient out-of-pocket costs based on the initial list price of a medicine rather than the discounted cost negotiated with the pharmaceutical manufacturer.
Patients Currently Pay More
PBM Exploit the State of Ohio and its Independent Pharmacists
Some local independent pharmacies have been forced out of business because PBMs often reimburse pharmacists less the costs for filling a prescription. At the same time, Ohio is being overcharged by PBMs.
Investigators have found that while PBMs were shortchanging local pharmacies in Ohio, the PBMs turned around and overcharged Ohio Medicaid by more than $240 million.
State policymakers are examining innovative approaches to fix this system by assuring that savings negotiated with prescription drug manufacturers are actually passed through as lower costs paid by taxpayers, patients, and public and private sector health plans, and patients for the prescription medicines they need. One of the most promising and successful of these solutions is the “PBM Reverse Auction,” which helps transform the opaque and uncompetitive process for setting prescription drug prices into a transparent, dynamically competitive marketplace where PBMs would compete with one another for any given state’s business. Three states have already taken action:
We're finding solutions to:
Effectively drive down prescriptions drug costs
Ensure Ohioans still have access to the providers and medicines they need
Respect Ohio taxpayers and save money for families and communities
Address budget issues our state faces due to the pandemic