Holding pharmacy benefit managers accountable is crucial in Delaware

Delving into the world of pharmaceuticals is not an easy feat, but it is a necessary one.

Access to affordable, quality health care is critical in not only Kent County, but across our state, and it has been my goal to break down barriers and red tape associated with a key piece: medication costs.

The rising cost of prescription drugs force Delawareans to make difficult choices every single day: Do I pick up my diabetes medication or pay my rent or buy groceries? It’s not a fair choice. That’s why I’ve fought to hold pharmacy benefit managers accountable with my colleagues and Delaware Insurance Commissioner Trinidad Navarro.

Rep. Andria Bennett
Rep. Andria Bennett

You might ask – what is a pharmacy benefit manager and how does it impact my medication cost? In short, it impacts a lot. Pharmacy benefit managers are vastly unregulated third-party drug administrators that act as middle men between health plans, pharmaceutical manufacturers and pharmacies. They can manage coverage, negotiate discounts and savings and process pharmaceutical claims. In fact, two-thirds of the 6 billion prescriptions that are written each year in the United States are processed by a PBM.

However, instead of slicing red tape and working for the consumer, the unregulated nature of PBMs proves to be detrimental, allowing them to shake up the market and pocket any prospective drug savings instead of passing them on to the consumer. The lack of transparency is problematic, which is at the root of our successful legislative efforts.

HB 194, which was passed and signed into law this year, requires PBMs to register with the Delaware Insurance Commissioner and permits the office to examine their affairs, issue cease-and-desist orders based on certain fraudulent acts or violations, and impose fines and action plans if needed. PBMs also must maintain records of services provided and establish a more transparent appeals process for pharmacies if they are not reimbursed correctly.

Basically, the new law puts consumers – not profit – first. And we have done more to put money back into residents’ pockets rather than lining the pockets of the industry.

I’ve championed HB 24 to eliminate “pharmacy clawbacks” that allowed PBMs to keep the difference if the total cost of a medication is less than an individual’s co-pay. We also pushed HB 425 last year, which removes barriers so pharmacists can speak to patients about the most affordable price for their medication. Both bills have been signed into law, and I’m proud that we’ve taken these steps.

However, we cannot remain complacent. Even though we’ve made progress, ensuring Delawareans have access to affordable medication still takes collaboration and creativity. That’s the goal of my new Pharmacy Reimbursement Task Force. We will be taking a deep dive into pharmacy benefit manager practices and reimbursements, where there have been concerns to both consumers and pharmacies.

As chair of the task force, I’ll be leading the efforts to study pharmacy reimbursement practices in Delaware, and across the country. We owe it to the residents of our state to fight for their best interests, increasing access and affordability to needed medications. Our residents deserve to pocket any savings, not over-bloated, under-regulated big pharma middle men. And our residents certainly don’t deserve to be taken advantage of. I look forward to our continued efforts and discussion to that end.

EDITOR’S NOTE: State Rep. Andria Bennett, D-Dover South, represents the 32nd District in the Delaware House and is Vice-Chair of the House Economic Development/Banking/Insurance & Commerce Committee.

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