From WisPolitics.com/WisBusiness.com …
— Lawmakers have reintroduced a bipartisan bill aiming to protect independent pharmacies and ensure patients can access the medications they need by changing the way pharmacy benefit managers are regulated in the state.
Pharmacy benefit managers, or PBMs, are entities contracted to administer or manage prescription drug benefits on behalf of an insurer, cooperative, or other entity that provides prescription drug benefits to Wisconsinites.
The bill, introduced by Senate President Mary Felzkowski, R-Tomahawk, and Rep. Todd Novak, R-Dodgeville, largely mirrors last session’s version of the bill. The proposal didn’t get a vote in either chamber. Felzkowski said the only substantial change is a new provision requiring PBMs to reimburse pharmacies within 30 days.
The bill, dubbed “Cole’s Act,” is named in honor of Cole Schmidtknecht, a 22-year-old Wisconsinite who died of an asthma attack after a PBM changed coverage of his daily steroid inhaler, bringing the price from $66 to $539.19, which he couldn’t afford.
Cole’s father, Bill Schmidtknecht, said his son died “due to the unchecked power and harmful practices of the top pharmacy benefit managers.”
“He was full of life, he had dreams for the future, and he should still be here today,” he said.
Cole’s family has filed a federal lawsuit alleging the price increase led to their son’s death.
Some of the measures in the bill would:
- Require PBMs to pay pharmacies and pharmacists at least the cost to acquire a drug, and allow pharmacies and pharmacists to decline to provide a drug if they would be paid less than the cost to acquire it;
- Require PBMs to pay a pharmacy or pharmacist a professional dispensing fee of at least what it costs the state to pay for each drug under the state’s Medical Assistance program;
- Expand pharmacy benefit plan participants’ access to more pharmacies in the state;
- Prohibit PBMs from using different copays or additional fees to incentivize program plan participants to use specific pharmacies; and
- Impose restrictions on audits of pharmacists and pharmacies.
Sean Stephenson, a lobbyist with the Pharmaceutical Care Management Association, knocked the proposal.
“The legislation strips away the flexibility that Wisconsin’s employers, unions, and public healthcare have to design prescription drug benefits, which will result in higher drug costs for the health plans and for patients,” he said.
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