Investigate and Control Pharmacy Benefit Managers (PBMs)

RI State Legislators, Office of Health Insurance Commissioner Patrick Tigue, and RI Medicaid Program Director Benjamin Shaffer

Pharmacy Benefit Managers

About 40% of Americans struggle to afford their regular prescription medicines - with 1/3 saying they have skipped filling a prescription one or more times, because of the cost.  COVID-19 has exacerbated the problem by causing job and health insurance loss and delaying routine care.

Rhode Island policymakers know skyrocketing prescription drug prices must be better controlled.

Unfortunately, they have ignored a key cost driver: Pharmacy Benefit Managers (PBMs).

PBMs such as CVS Caremark, Express Scripts and OptumRx “manage” prescription drug benefits on behalf of insurers and siphon off enormous revenues in the complex non-transparent system that gets drugs from manufacturers to patients.

Other states are doing a much better job monitoring and controlling PBMs and have saved consumers and tax payers hundreds of millions of dollars.  

Rhode Island should follow their lead.

For more information, see https://upriseri.com/pharmacy-benefit-managers/


To: RI State Legislators, Office of Health Insurance Commissioner Patrick Tigue, and RI Medicaid Program Director Benjamin Shaffer
From: [Your Name]

Despite providing no actual healthcare, middlemen Pharmacy Benefit Managers (PBMs) like CVS Caremark, Express Scripts and OptumRx are:

1) a significant and largely hidden cause of high prescription drug prices and limiting patient access; and
2) ignored by RI healthcare cost analysts and policymakers trying to contain costs and improve access.

Rhode Island legislative and executive branch officials should more aggressively rein in PBMs by taking the following actions.

1. Require PBMs to disclose information that results in effective ongoing state oversight and control of PBMs.

2. Pursue appropriate civil and criminal investigations and actions.

3. Carve out PBMs from Medicaid Managed Care Organization (MCO) contracts set to renew in April 2022.

4. Restrict unjustified PBM revenues, such as those arising from spread pricing, “claw backs,” “pharmacy steering,” discriminatory reimbursements, manufacturer rebates, and Section 340B transactions.

5. Restrict harmful Insurer/PBM utilization management practices, such as, Prior Authorization, Step Therapy and Non-medical Drug Switching.

6. Establish an unbiased research group to analyze ALL potential healthcare cost drivers, including private middlemen insurers and PBMs.

Other states are already protecting their consumers and tax payers from high prescription drug prices by undertaking these kinds of actions. Rhode Island should follow their lead.

For more information, see the article in UpriseRI, "Mystery Bureaucrats Managing Your Prescription Drugs: Pharmacy Benefit Managers (PBMs)" https://upriseri.com/pharmacy-benefit-managers/