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Felzkowski brings back PBM bill

Felzkowski brings back PBM bill

Senate President Mary Felzkowski, R-Tomahawk, is bringing back sweeping legislation aimed at reigning in pharmacy benefit managers that failed to pass last legislative session.

Felzowski and Rep. Todd Novak, R-Dodgeville, announced the bill at a press conference Tuesday at the state Capitol. Felzkowski said it’s similar to a previous measure she spearheaded, with one change: PBMs would need to reimburse pharmacies within 30 days.

“After talking to some of our independent pharmacies, we found that PBMs were not paying in a timely manner,” she said.

The bill would prohibit PBMs from reimbursing pharmacies below the cost of a prescription, bar them from dropping coverage of a drug in the middle of the year and require PBMs to count copayment assistance from drug companies toward patients’ annual deductibles and maximum out-of-pocket cost.

In addition, the bill prevents PBMs from paying providers in the federal 340B program at a rate lower than what they pay for the same drug to providers not involved in the program. They also couldn’t impose restrictions on 340B providers that are not applied to others and couldn’t restrict networks based on 340B participation.

“PBMs take advantage of community health centers by offering poor terms in the contracts based solely on an organization’s participation in the 340B drug pricing program,” said Richelle Andre, government relations specialist for the Wisconsin Primary Health Care Association. “This pulls dollars directly out of the pockets of patients and the healthcare organizations that serve them.”

In a statement, the Alliance of Health Insurers said that PBMs are the primary lever available to health plans and employers to ensure that patients can obtain the medications they need at the lowest possible cost.

“Our healthcare system is complex. Adding significantly more regulation to one of the few entities that exist to negotiate lower healthcare costs is not the solution,” the association said.

PCMA, a trade association representing PBMs, echoed that statement.

“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,” said Sean Stephenson, senior director of state affairs.

Felzkowski and Novak are naming the bill Cole’s Act, in memory of Cole Schmidtknecht, who died last year from an asthma attack after he stopped taking a daily steroid inhaler when his insurance halted coverage. Cole’s family is suing Optum Rx and Walgreens for wrongful death.

Felzkowski said she’s more optimistic about the bill’s chances this time around because of the number of constituents and employers she’s heard from who want lower healthcare costs.

“We heard loud and clear on the campaign trail that constituents are very unhappy with healthcare in Wisconsin,” she said.

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