Helena, Mont.- In 2021, Commissioner Downing requested legislation which was introduced by Senator Hertz to oversee Pharmacy Benefit Managers (PBMs). The bill became law and requires PBMs to be licensed and provide an annual transparency report to CSI.
PBMs are paid by the health plan to create a formulary, which is a list of drugs that the health plan will cover. If a drug does not make it onto a particular formulary, the manufacturer may lose revenue by not selling certain drugs. To entice PBMs to add their drugs to a formulary, drug manufacturers may use rebates as an incentive. These rebates don’t always get passed along to the health plan or the consumer.
“The goal of this law is to lower prescription drug prices for Montanans,” Downing said. “By requiring PBMs to report rebates and fees, it helps health plans see behind the curtain and negotiate better contracts which may help lower the ultimate cost to the Montana consumer.”
For this report, PBMs were required to submit information to the CSI for 2022 transactions. CSI provided a template to PBMs with the required data elements at both the aggregate and claim level.
Eighteen PBMs reported a total of $268.6 million of total prescription drug spending on Montana consumers across 153 health plans, plan sponsors, and workers’ compensation plans. The report can be found HERE.
Troy Downing is the Commissioner of Securities and Insurance, Montana State Auditor. Commissioner Downing is a two-tour combat veteran, businessman, and entrepreneur.
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