Policing drug price middlemen’s middlemen
pay no more than is absolutely necessary for
IT'S TIME TO MAKE OUR HEALTHCARE 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.
PRESCRIPTION DRUG PRICING AND PBMs
As large companies that act as middlemen between prescription drug manufacturers, public and private sector health plans, and pharmacies that ultimately sell prescription drugs to patients, PBMs are heavily involved in the drug pricing process.
the prescription drug benefit for public and private health insurers;
which drugs will be covered by insurance plans, making lists of allowed drugs called “formularies”;
where a patient can – and cannot – obtain their medications;
the reimbursement rates paid to pharmacies for filling prescriptions; and
the rates charged to employers and government payers.
The Columbus Dispatch “Side Effects” series highlights some of the many issues in our state.
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.
Savings Should Be Directed to Ohio Patients, Businesses, & Taxpayers:
Patients Currently Pay More
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 patient out-of-pocket costs, but PBMs are keeping these savings for themselves.
PBMs 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 than what it costs to fill 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.
PBMs are Keeping Employers in the Dark
PBM contracts with employers are often overly complicated, ambiguously worded, and often benefit the PBM at the expense of the employer. One study shows that three in five employers think their contracts with PBMs are problematic.
States have made significant changes to the way they work with PBMs, creating a groundbreaking competitive marketplace for contracting of prescription drug benefits. The online reverse auction model has enabled states to reduce spending on prescription medicines, without any reduction in benefits, including:
Ohio has passed legislation and is awaiting implementation of the reverse auction to secure prescription drug savings.
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