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Point of View: Time to end PBM price gouging

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Debra Billingsley
Debra Billingsley

Prescription drug prices are out of control. For too long, large corporations have used legal loopholes to profit off of those in need, and it's time to pass legislation to curtail these harmful practices. House Bill 2632 and Senate Bill 841 are making their way through the legislative process with the goal of giving you the right to choose your pharmacy while providing greater transparency in the prices you pay for drugs.

With less-expensive options becoming more available, many are asking why our prescription drug prices continue to rise. Part of the answer involves a middleman that Oklahomans have never heard of called a pharmacy benefit manager or PBM. Originally, these PBMS only processed prescription claims for insurance companies and plan sponsors. Today they have taken over the prescription drug market. Each of the top three, CVS Caremark, Express Scripts (ESI) and OptumRX, rakes in more than $15 billion annually and control 80 percent of the prescription drug market. They do this while trying to convince us they are holding down costs on prescription pricing.

There is no oversight of PBMs, but Oklahoma and other states have taken notice. In fact, 230 bills have been filed in 46 states to curb PBMs' harmful practices, including the use of “gag clauses.” These prevent pharmacists from sharing with customers the benefits of paying the out-of-pocket price, instead of using insurance. HB 2632 and SB 841 would stop this deceptive practice.

PBMs can require you to shop at PBM-owned pharmacies, but under the new legislation they could not force you to shop at a specific pharmacy, including mail order. This allows you to choose your pharmacy. If these bills become law, Oklahomans would no longer have to send an estimated $1.4 billion to out-of-state mail order pharmacies. This would strengthen face-to-face interventions and drug interactions related to drug abuse, which results in a healthier Oklahoma.

Of course, PBMs claim these bills increase costs. In truth, they would save patients money by creating transparency and forcing PBMs to lower premiums, lower co-pays or expand coverage rather than pocket the difference. When Ohio audited its Medicaid drug program, it found PBMs pocketing $225 million per year. New York discovered $300 million, Kentucky $123 million and the list goes on.

A free and open market is the foundation of a dynamic economy. That includes your right to choose where you get your prescriptions. Ask your legislators to support the passage of HB 2632 and SB 841.

Billingsley is executive director of the Oklahoma Pharmacists Association.

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