PHARMACY BENEFIT MANAGER SETTLES CASE, ROSENDALE ANNOUNCES PRESCRIPTION DRUG SAVINGS INITIATIVE

csimt 2018, Insurance, Legislature, Press Release

SETTLEMENT IS LATEST DEVELOPMENT IN ROSENDALE’S EFFORT TO REDUCE PRESCRIPTION DRUG COSTS

HELENA, Mont. – Prime Therapeutics, the pharmacy benefit manager (PBM) of Blue Cross and Blue Shield of Montana, has settled a case with Commissioner Matt Rosendale’s office and agreed to pay up to $375,000 for an independent examination of its data.

The settlement with Prime follows Rosendale’s administrative actions against pharmacy benefit managers in June of this year for alleged violations of Montana insurance law. The case against Prime is the first to reach a resolution. Rosendale’s office has additional actions pending against Express Scripts and Aetna.

Prime has agreed to pay the costs of an independent, third-party examination of its data by Remedy Analytics as part of the settlement. The analysis is expected to cost Prime up to $375,000.

Rosendale announced the settlement with the pharmaceutical industry middleman as the latest development in his office’s prescription Drug Savings Initiative to reduce the incredibly high costs of prescription drugs and reform the way the pharmaceutical industry operates in Montana.

“This is a step in the right direction for tackling the high costs of Montanans’ medications and health insurance rates,” Rosendale said. “The drug industry hides behind its complexity and claims it has consumers’ best interests at heart. The data will prove whether that claim is true or false.”

Rosendale began investigating the high cost of prescription drugs nearly two years ago. His office has since launched a full court press against pharmaceutical industry practices that harm consumers and drive up costs, an effort Rosendale has dubbed the Drug Savings Initiative.

As part of the Drug Savings Initiative, State Senator and orthopedic surgeon Dr. Al Olszewski (R-Kalispell) is sponsoring legislation drafted by Rosendale’s office to reform the way the prescription drug industry operates in Montana.

Senate Bill 71 would make insurance companies accountable for the prescription drug benefits offered through their health insurance plans. It would eliminate unethical practices, including kickbacks, price gouging, and clawbacks by pharmaceutical industry middlemen that result in Montanans overpaying for medication.

SB 71 will be introduced in the 2019 Montana legislative session and has been called “groundbreaking” in its approach to tackling drug costs by health care industry experts. Rosendale’s office is working with other states to get Montana’s unique legislation passed throughout the country.

Rosendale’s chief legal counsel, Kristin Hansen, is leading the Drug Savings Initiative for the office and explained why SB 71 is necessary.

“We have analyzed state legislation nationwide and found most of it doesn’t work or was overturned in court,” Hansen said. “We had to start fresh, examine the pharmaceutical industry, and write legislation attacking the costs head on. Senate Bill 71 is a uniquely Montana approach that we’re encouraging other states to adopt as well.”

In addition to legislation, Rosendale’s Drug Savings Initiative includes legal actions against pharmacy benefit managers, leading the Legislature’s interim study on drug costs, coordination with other states and members of Congress, and hiring a Montana expert who saved the state’s health plan $7.4 million in prescription drug costs by enacting similar reforms as those contained in Senate Bill 71.

A new webpage outlines the Rosendale’s Drug Savings Initiative for the public and includes links to relevant legislation, presentations, and news reports: https://csimt.gov/prescription-drug-costs/.

The Prime Therapeutics Consent Agreement and Final Order can be found HERE.

 

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