MADISON, Wis. (SPECTRUM NEWS) – Patients and pharmacists across Wisconsin team up to lower prescription costs.
The Wisconsin Pharmacy Patient Protection Coalition (WPPPC) wants to fix what they call a problem with the state's Pharmacy Benefit Managers (PBMs).
“Created by insurers years ago to save patients money by negotiating drug prices with manufacturers, the PBM middlemen are now manipulating the system in unintended ways for their own profit,” Rob Gundermann, Chair of the Wisconsin Pharmacy Patient Protection Coalition, said. “Under current law, PBMs are pocketing savings meant for consumers and their actions are drastically driving up prescription costs.”
PBMs are third-party administrators of prescription drug programs for commercial health plans.
The WPPPC says the PBM industry is hurting vulnerable patients by forcing them to unknowingly pay high prices for prescriptions.
The legislation would require PBMs to register with the state, create price transparency requirements, and get rid of a gag clause on pharmacists.
Becky Conder from Delavan knows the issue as both a pharmacy technician and as a patient herself.
“In the pharmacy, I should be able to tell somebody, you know, if you don't use your insurance you can get this medication for $10, but if I bill your insurance going to be $50,” Conder said.
Conder uses her husband's insurance to cover medication for her heart condition.
When Conder's doctor increased the dose of medicine she was already taking, the PBM would only pay for a mail-order which would have taken seven to 10 days.
Conder couldn't go without her medicine so she had to pay out-of-pocket.
“For a 30-day supply it's $62 where the mail order was going to make us do a 90-day supply, which I really didn't need because it was something we were trying, for $4, so I paid $58 more for less amount of pills,” Conder said.
The bills also make sure patients don't get denied during a plan year if their medication was covered when they enrolled or renewed their coverage.
“I really don't think a lot of people realize all of the things that are going on behind-the-scenes of PBMs that negatively impact prescription costs,” Jason Schwager, a pharmacist at Hometown Pharmacy in Watertown, said. “I do know this, people are fed-up.”
The coalition unveiled a petition this week of nearly 11-thousand signatures from Wisconsin patients calling on lawmakers to pass new regulations.
Similar legislation has been proposed across the country and laws have passed in 33 states so far.
In Wisconsin, more than 95 co-sponsors signed onto the bipartisan legislation supporting new regulations.
Primary sponsors of the bills include State Sen. Jon Erpenbach (D-West Point), State Sen. Roger Roth (R-Appleton), State Rep. Michael Schraa (R-Oshkosh), and State Rep. Debra Kolste (D-Janesville).
Lawmakers hope to pass some version of the bills soon.