Georgia House Republicans say big pharmacy managers cause pain

Dr. Jean Sumner told a panel of state House lawmakers recently that pharmacy benefit managers are making care more complicated and are taking decisions away from doctors and pharmacists who know their patients. Maggie Lee/Georgia Recorder

The prescription drug cards in many Georgians’ pockets could come courtesy of companies that Georgia House Republicans say are fleecing people and the government.

The state House GOP caucus is threatening new regulations on those so-called pharmacy benefit managers. Health insurance companies hire them to administer their drug plans and negotiate better prices. But the benefit managers are drawing increased scrutiny and Georgia lawmakers might tack on more regulation to a law that just took effect Jan. 1.

“They say sunlight is the best disinfectant and that’s what today is all about – shining a light on harmful practices that raise prescription drug prices, hurt patients, providers and taxpayers,” said state Rep. Matt Hatchett, a Dublin Republican. He was opening a nearly three-hour-long hearing last week that lined up doctors, patients and pharmacists against the companies that manage prescription drug programs on behalf of employers, large insurers and others. That involves negotiating drug prices. Examples of big prescription managers include CVS Caremark, Express Scripts and OptumRx.

Dr. Jean Sumner named those three in her testimony at the state Capitol. The Wrightsville internist and dean of Mercer University’s School of Medicine said some management practices interfere with patient access to drugs without better results.

“I should be able to write [a prescription for] the cheapest, safest, most effective drug,” Sumner said. “I can’t anymore. I have to write what’s on your list, and what’s on your list is the most profitable.”

Sumner said some plans require name-brand pills at a markup even when generics would cost less than pennies on the dollar.

She also said she’s seen patients directed by prescription managers to use CVS or Target even when her rural patients live nowhere near those stores and prefer a nearby pharmacy.  

A Georgia law that took effect at the beginning of this year is designed to end benefit company steering of business toward pharmacies they own.

In a statement, a national pharmacy benefits managers trade group called last Tuesday’s hearing “unproductive toward finding real solutions to reduce prescription drug costs in Georgia.”

The benefit managers are already heavily regulated by state and federal governments, wrote Greg Lopes with the Pharmaceutical Care Management Association.

A “PBM’s core mission is to advocate on behalf of patients by negotiating with drug manufacturers to reduce prescription drug costs,” Lopes wrote.

The association claims the system will save the state and its residents nearly $12 billion on drug costs over the next 10 years.

But prescription managers also receive rebates from drug manufacturers — which is controversial because it may incentivize PBMs to steer patients toward pricier medications.

The state of Georgia itself contracts with prescription managers to serve state employees and Medicaid recipients.The GOP’s proposed legislation would remove pharmacy benefit managers from Medicaid care in the state, inspired in part by West Virginia. West Virginia calculates that in the year that ended on June 30, 2018, eliminating the benefit managers saved $54 million.

Georgia Republicans are also promising more oversight and transparency measures, but no bills are prepared yet.

For years, lawmakers have also heard from people like Katie Groover, who’s depended on experimental drugs, foundation assistance with her medical bills and as many as four pharmacies at a time as she’s battled multiple myeloma cancer.

Groover estimates she used to spend hours every month in frustrating phone calls with Accredo, a specialty pharmacy owned by Express Scripts. And that it stopped sending her medication without a word when her foundation assistance ran out.

“It is exhausting and it is anything but patient care,” Groover said at the hearing.

Patients like Groover have a sympathetic audience at the state Capitol.