Pharmacy benefit managers or PBMs for short, now wield nearly limitless power and influence over the prescription drug market owning at least 85% of pharmaceutical industry. Their tight grip on the market has allowed them to engage in unfair pricing practices with very little oversight. They can raise the price you and your insurance company pay for medications, and instead of passing that revenue along to pharmacies, they keep it for themselves. Without having to answer to anyone, they rake in the cash off consumers backs and hurt patients in the process.
Which leaves the question, what is being done about it and how are they not being regulated? Well, let’s dive in …shall we.
A bill was presented at the state level during last session to demand PBM reform, unfortunately it didn’t even get called to vote.
“Why it didn’t get voted upon is something that will anger me forever, because it has everything to do with politics and money and had nothing to do with the right thing,” said Dan Strause former CEO of Hometown Pharmacy.
Wisconsin Representative Micheal Schraa, shares some insight.
“The general public has no clue. I spoke at a Republican Lincoln day dinner about three weeks ago. And I said how many people in this room, and there were about 140 people, how many in this room know what a PBM is, pharmacy benefit manager, six hands went up,” said Schraa.
Yet the negative Impact PBMs have on the nation’s healthcare system is growing daily. As more and more small pharmacies are getting smothered out of the equation.
Schraa said his drive to push PBM Reform legislation started about 10 years go when his pharmacist Ken brought it to his attention.
“I walked in one day and Ken just said, you got to sit down with me, and I got to tell you what’s going on. Were getting killed by these things, by these PBMs, and I’m like what’s a PBM, I never heard of it before,” said Schraa.
Micheal said he started doing his own research and asking questions, the more he learned the more eye opening it was to him. That something needed to be done.
“There we a lot of powerful statements and a powerful testimony from people that had personal experiences with how the PBMs have negatively affected them. So, it’s just been my mission. I knew I would be coming again this session with another bill. Senator Felzkowski and I worked on it and it was really frustrating at the end, not having it go anywhere.
Bill 737 had 104 co-sponsors on it out of 132 legislators. Schraa personally went to every single democrat and republican office in efforts to get as much bipartisan support on the bill as possible. But it never even got called to the floor to be voted upon during the last legislative session. There were 13 separate asks in the bill and there were even efforts made to amend a single one of these asks into a separate bill, pertaining to hospitals, that would demand some transparency from PBMs regarding formularies. (Called MAC Pricing Language which is a spread showing the average cost of a drug across all companies that manufacture that drug.) In hopes that it would be the most beneficial piece to independent pharmacies.
“So, we had this amendment and we added it to another bill that the hospitals really needed. We felt this was a bill that couldn’t be killed and wasn’t going to have an issue in the Senate,” said Schraa.
“The Mac language was kind of watered down a little bit, but we still got a chunk of it in there. I thought this is great. The governor’s office was in they didn’t like a little bit of wording so we changed it to appease them so they would sign the bill, or sign the bill that this amendment went to, and we passed it. And it went over the senate and died,” said Schraa.
There are many speculations as to why the PBM reform bill, has been avoided.
“The ugly part of politics is that campaigns cost a lot of money to run and not everybody can self-finance especially in the assembly or the senate,” said Schraa.
However, Schraa said there are still those willing to fight for the people and what’s right.
“That’s where the heart of this issue comes in. There’s 30-some other states that have passed pretty significant PBM reform. The decision makers in those states have made a decision, we’re going to stand up for the people,” said Schraa.
Schraa has a plan for the next legislative session to break down this complex bill and get it passed.
“It’s a complicated issue,” said Schraa. Unless you’re a pharmacist or someone who works with this everyday it can be really hard to focus on the several different things this bill highlights. Schraa plans to break it down to have a legislator for each section.
“That way I think the health plans and PBMs that are against this, its going to be a lot harder for them to come in and trash 12 or 13 different legislators. They were going around lobbying in each office saying, you know Schraa’s PBM bill is going to raise prescription drug costs, out right lying,” said Schraa.
Schraa said he understand lobbyists and their job is to protect their clients.
“There’s so much money in this game for them and they’re so powerful and the lobbying core is so well paid,” said Schraa.
Schraa said it’s frustrating because he sees the net effect that PBMs are having on so many people including his own family, who have fallen victim to adverse medical reactions due to wrongful practices. Schraa said, he and fellow supporters will continue to bang their fists on the desk until PBM reform is accomplished.
“The education process is huge, and I think this patient protector will be a game changer. It’s going to be super hard for them to continue to shovel this underneath the table and try to hide it. When you have so many different avenues bringing the light out and exposing, you know light is the best disinfected and that’s starting to happen,” said Schraa.
That’s why patientprotector.us was created, if you or a loved one are being affected, share your stories on the online portal so they can be heard by legislators and a difference can be made.
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