Lawmakers seek to regulate the prescription price process

Politics

INDIANAPOLIS– Many independent pharmacies in Indiana are struggling and turning away some patients as a result.

It’s all due to the way prescription prices are negotiated.

The state is working to help but regulations can only go so far.

George’s pharmacy on the East side of Indianapolis is one of eight in Indiana but the owner said they’re all at risk if something doesn’t change soon.

“Independent pharmacies are either closing up or they are selling to one of the big boys,” said Blake Gillman, owner and CEO of George’s Pharmacy and Medical Equipment.

He said the reason pharmacies are moving in that direction is hidden prescription price negotiations set by Pharmacy Benefit Managers or PBMs.

“It’s something where they are playing by their own set of rules,” said Gillman.

Pharmacy Benefit Managers act as the middleman between the manufacturer and the pharmacy

“It was a conduit for manufacturers to try and get their drugs to the marketplace,” explained Republican State Senator Andy Zay.

The Pharmaceutical Care Management Association said PBMs are patient advocates and work to lower prescription drug prices.

But Sen. Zay and Gillman argue, without Indiana requirements, it’s difficult to see who is pocketing the negotiated savings.

“Hidden contracts, things that you don’t know don’t see and there’s zero transparency,” explained Gillman.

States weren’t allowed to regulate PBMs until a Supreme Court ruling approved it in December.

Now, lawmakers look to add transparency and Zay is one of the people leading this effort.

“What we are trying to do is create an appellate process, an internal appellate process between the pharmacy and the Pharmacy Benefit Manager because in some cases with the rebates or the clawbacks that they are getting, pharmacies are actually losing money,” explained Zay. “The appeal of the drug is actually with the insurance commissioner, so they can act as an independent arbiter.”

Gillman supports the legislation.

“This has been a long time coming so, it’s going to be a very good thing,” said Gillman.

It just might save his family-owned pharmacy chain of 36 years.

If you would like to learn more about the proposals concerning PBM regulations at the Indiana Statehouse, click the bill links below.

SB 143

HB 1393

SB 62

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