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PBM press conference

A bill designed to drive down prescription drug costs in Wisconsin has bipartisan support from a group of lawmakers who say it will benefit both consumers and local pharmacies. 

The legislation — unveiled on Tuesday by Sens. Roger Roth, R-Appleton; Jon Erpenbach, D-Middleton; and Reps. Michael Schraa, R-Oshkosh; and Debra Kolste, D-Beloit — creates new rules for pharmaceutical benefit managers, or PBMs, which act as go-betweens for pharmacies and health insurance companies by managing prescription drug plans, negotiating prices and processing claims.

"The high price of prescription drugs is something we as legislators hear on almost a weekly basis from constituents," Kolste said. "We need to be confident that PBMs are not abusing their position in the marketplace as middlemen and are acting in the best interest of their clients and patients."

The bill would prohibit PBMs from enforcing "gag clauses," which prevent pharmacists from telling customers when a prescription is available at a lower price by paying cash than by going through insurance. It would also ban "co-pay clawbacks" — situations in which an insured consumer's co-payment is more than the total cost of the drug to the insurer or the PBM.

The legislation would also ban PBMs from charging patients more to fill their prescriptions at a brick-and-mortar pharmacy than by using a mail-order service, or from instructing patients to use a PBM-owned pharmacy rather than another pharmacy in the patient's network.

According to the National Conference of State Legislatures, at least 29 states have enacted laws banning "gag clauses" and at least 20 have banned "co-pay clawbacks."

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Pharmacy Society of Wisconsin chairman Nick Olson praised the proposal, which he said would "create real, meaningful impact to patients at pharmacy counters throughout Wisconsin."

Similar legislation introduced last session by Erpenbach and Kolste failed to pass. 

Roth said he signed onto the proposal after hearing from pharmacists and constituents in his district about the high cost of prescription drugs. 

"We in the Legislature … on the larger level, all agree on what we want to do when it comes to health care — we want to improve access, we want to improve the quality, we want to improve affordability," Roth said, adding that Democrats and Republicans can agree on the "common-sense reforms" proposed in the PBM legislation. 

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Jessie Opoien covers state government and politics for the Capital Times. She joined the Cap Times in 2013 and has also covered Madison life, race relations, culture and music. She has also covered education and politics for the Oshkosh Northwestern.