Republican lawmakers introduced a bill Tuesday to reform pharmacy benefit manager (PBM) practices by lowering drug costs and increasing transparency in Wisconsin during a press conference.
The bill, authored by Sen. Mary Felzkowski, R-Tomahawk, and Rep. Todd Novak, R-Dodgeville, is titled Cole’s Act, named after Cole Schmidtknecht, a 22-year-old from Poynette who died from an asthma attack after PBM practices led to his daily steroid inhaler jumping from $60 to $539.19. PBMs are companies that negotiate between pharmaceutical companies, insurers and pharmacies on drug prices and covered medications.
“[Cole] ultimately made the choice between filling that prescription or paying his rent,” Cole’s father, Bill, said in a video played at the start of the press conference. “Honestly, had he been notified of [PBM practices] or given different options, would my son be here?”
A recent survey by the American Medical Association found that 72% of people with a commercial or Medicare Part D plan were covered by insurers that were vertically integrated with a PBM, which leads to a lack of market competition in health care.
In markets without fair competition, companies are given more leverage to raise prices to maximize profits. A memo given at the press conference said Cole’s Act would shield pharmacies from rising dispensing fees and provide “regulation for fair audit practices limited to waste, fraud and abuse.”
The bill would also help to protect 340B providers who give medicines and services to low-income and uninsured patients under special regulations from having PBMs take taxpayer money in these transactions.
“Many of the elderly we care for are unable to travel to care outside their area,” said Josephine French, chief pharmacist at Trig’s in Rhinelander. “The impact PBMs are having on rural pharmacists is staggering. They dictate where prescriptions can be filled, what the pharmacy can charge and what they will reimburse.”
French claimed that PBMs have often not reimbursed pharmacists for prescription costs in a timely manner, leaving pharmacies to pick up the bill on their own. This creates an unsustainable business model for pharmacies that leaves them at risk of shutting down.
“When a local pharmacy shuts down it’s more than just a business closing, it’s a loss of accessible health care,” said Larry Crowley, a pharmacist from Dodgeville. “Many of these communities no longer have a doctor’s office or a clinic.”
The Wisconsin Legislature has previously identified close to 150 areas across the state that are experiencing shortages of primary care providers, primarily in rural communities.
The bill would also address lower income individuals with conditions like HIV whose medication could be at risk under current policies.
The federal 340B drug pricing program allows Vivent to purchase medicines at a discounted price and requires us to reinvest those savings into services for uninsured and low-income patients with HIV, Bill Keeton, vice president and chief advocacy officer at Vivent Health, said.
The legislators remarked that this bill was introduced early in the legislative session because broad concerns from Wisconsinites on access to health care gave them hope of bipartisan support.
“On the campaign trail last year, we heard loud and clear from constituents that health care in Wisconsin is not working for our constituency, and we have also heard that loud and clear for employers,” Felzkowski said. “I’ve talked to legislators in other states, and they said they couldn’t do a sweeping reform bill. I think Wisconsin’s better than that.”
On the national level, Reps. Diana Harshbarger, R-Tenn., and Jake Auchincloss, D-Mass., have introduced the Patients Before Monopolies Act to limit the power of PBMs. A date has not been set to discuss the bill.
