LINCOLN, Neb. (WOWT) – Pharmacy benefit managers (PBMs), were created decades ago to process claims for insurance companies and save money for consumers.
At a hearing Tuesday, some told the Banking, Commerce and Insurance Committee that things have changed though.
“Now, PBMs collect rebates from drug manufacturers on top of premiums,” Nebraska Pharmacists Association CEO Marcia Mueting said. “They conduct predatory audits that have become a profit center, they reimburse pharmacies at below-cost rates and offer contracts to pharmacies that are not negotiable, and PBMs are posting record earnings.”
State Sen. Justin Wayne has one bill that would keep PBMs from reimbursing pharmacies at a lower rate for drugs than it costs to dispense them.
Those testifying in favor of it said smaller, independent pharmacies cannot stay afloat with those conditions.
“Even with processing over 12,000-13,000 prescriptions a year, the current losses are unsustainable,” said Tom Choquette, who owns Bert’s Pharmacy in Hastings. “One of the three Nebraska Medicaid Providers, we’ve processed 2,285 claims this year, totaling a loss of $3,084.”
Opponents of the legislation said there are too many other factors at play to just zero in on PBMs.
“Let’s look at what the role the wholesaler and PSAO is in all these transactions because I want to understand more what limits there may be on pharmacies in terms of shopping around,” Pharmaceutical Care Management Association Vice President Bill Head said.
Sen. Eliot Bostar’s proposal would not allow PBMs to restrict how retail pharmacies dispense or deliver prescription drugs to patients.
The Community Pharmacy Enhanced Services Network in Nebraska welcomed the bill.
“Our sustainability has been compromised by PBM practices that steer our patients away from our care and into big box stores and mail-order services that are often, more often, owned by those same out-of-state PBM companies,” Staci Hubert said.
However, a lobbyist representing Prime Therapeutics said mail-order pharmacies have credentialing requirements for quality and safety measures.
“Community pharmacies should also be following those same requirements if they’re going to be doing mail order, and this bill prevents us from having specific networks that we would require them to join to do mail-order pharmacies,” Michelle Crimmins said.
Sen. Carol Blood of Bellevue has a bill that would establish an advisory council consisting of those representing pharmacists, consumers and drug manufacturers. It would negotiate lower prices on medications that are utilized the most in the state and are also considered to be the most expensive.
“I don’t fault any company if they make profits,” Blood said. “But in the United States, we’re making these profits on the backs of consumers.”
Critics said the upper payment limit in Blood’s bill is a price control that would impact purchase and reimbursement prices for medicine.
“It is really not clear how an upper payment limit would operate,” said Katelin Lucariello, a lobbyist for the trade group Pharmaceutical Research and Manufacturers of America. “It’s still an open question, as no state has done it yet.”
All bills must make it out of committee before being debated on the floor.
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