General Assembly Vote Tracker

HB24 – Clawback Ban

So here is a practice that I was unaware of: when the total cost of a prescription drug to an insurer or a pharmacy benefits manager is less than a patient/insured’s co-pay, the insurer or pharmacy benefits manager keeps the difference in a practice that is known as a “clawback.” Representative Andria Bennett has a new bill, HB24, that would end that practice.

According to a March 2018 report issued by the University of Southern California’s Schaeffer Center for Health Policy & Economics, almost 25% of filled pharmacy prescriptions involved a patient co-payment that exceeded the average reimbursement paid by the insurer by more than $2.00. The report further noted that overpayments were more likely to occur on claims for generic drugs than brand drugs and that the total overpayments in the Center’s sample amounted to $135 million.

My question is what happens to the clawbacked money? It’s obviously not given to the consumer, since a co-pay is a co-pay. The money goes to the insurance company, which I suppose the hope is would lead to lower co-pays. But the General Assembly might want to pass legislation to that affect. If I am understanding this correctly…

What is the bill? Out of Committee 1/23/19

Democratic Sponsors: Bennett, Sokola, Bentz, Dorsey Walker, Heffernan, Jaques, Kowalko, Seigfried, K.Williams

Republican Sponsors: Delcollo, Pettyjohn, Wilson

Yes Votes: Democrat, Republican

No Votes: Democrat, Republican

1 comment on “HB24 – Clawback Ban

  1. Dustyn Thompson

    I was blown away that this is a thing! How much more can the medical industry rip off consumers?

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