Movement to reform pharmacy middlemen reaches a boiling point nationwide

csimt In The News

By: Marty Schladen and Catherine Candisky

The Montana legislature recently passed a bill meant to attack the PBM problem. Senate Bill 71 would require the Montana Securities & Insurance Commissioner to regulate PBMs that serve private health plans on the individual market. Similar reforms already have been made for state employees through the companies that administer the state’s self-funded insurance plan. The change is intended to require insurers to look out for taxpayer interests and to give state regulators the power to effectively check insurers’ math…

That provision would prevent insurers from boosting profits by classifying some portion of rebates as a medical expense, said Derek Oestreicher, an attorney for the Montana insurance commissioner who was involved in developing the measure.

“It’s ultimately important that insurers take back the reins from pharmacy benefit managers,” he said, explaining that he’d seen crazy things as he worked on the bill. One PBM contract he saw defined “rebate” as a number of things — “rebates” not among them.

Marilyn Bartlett was recently named 13th on Fortune magazine’s list of the World’s Greatest Leaders for her work reforming how Montana does business with hospitals, managed-care companies and PBMs. She said it took a hard political fight to pass SB71 over the objections of insurers and PBMs. It remains to be seen whether Democratic Gov. Steve Bullock will sign the bill. His office didn’t respond to a call last week for comment.

Maine lawmakers began hearings this month on a sweeping package of five bills broadly modeled on the Montana legislation…

Company officials say making the contract public would give an unfair advantage to its competitors.

Montana’s Oestreicher isn’t buying that.

“Let’s be clear, we’re not dealing with the Coca-Cola recipe here,” he said. PBMs “are always coming up with more algorithms to become more profitable and more secretive.”

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