May 26 2011
WASHINGTON, D.C. – U.S. Senator Jerry Moran (R-Kan.) this week sponsored S. 1058, the Pharmacy Competition and Consumer Choice Act of 2011, legislation to increase choice and cost savings for patients in Kansas and across the country.
The Pharmacy Competition and Consumer Choice Act would increase the transparency and accountability of pharmacy benefit managers (PBMs) – companies that administer drug benefit programs for employers, health insurance plans and millions of patients. PBMs process prescription drug claims and update drug formularies, that determine which medications are covered under insurance plans and the amount owed by patients.
“This legislation would increase transparency and competition among PBMs, eliminate wasteful health care spending, and enable patients to go to the pharmacy of their choice,” Sen. Moran said. “In many Kansas towns, the local pharmacist is a person’s most direct link to health care and this bill would increase Kansans’ access to the pharmacies in their own communities.”
“We work every day with local residents to make sure they have the proper medications and dosages they need at the best value,” said Van Coble, owner of Medicap Pharmacy in Winfield. “But pharmacists in Kansas are concerned the current practices of many PBMs are hindering our ability to care for local patients. Sen. Moran’s bill would address this problem and lower medication costs for Kansans.”
The Pharmacy Competition and Consumer Choice Act would:
- Prohibit PBMs from requiring patients to use a specific pharmacy in which the PBM has an ownership interest;
- Protect patients’ sensitive health information by requiring notification and consent for PBMs to sell patient data or use it for solicitations;
- Require PBMs to make annual disclosures of health plan information to employers and other plan sponsors so they can evaluate the cost effectiveness of a plan;
- Require PBMs to provide timely reimbursement to pharmacies for undisputed claims; and
- Reduce abusive pharmacy audits by prohibiting PBMs from penalizing pharmacies for minor clerical errors where no proof of fraudulent intent or financial harm exists.