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Prescription Drug Clawback Ban Passes House

On Thursday, HB 24 passed the House 38-0, with three absences. The bill ‘would prohibit insurers and pharmacy benefit managers from engaging in the practice of “clawbacks,” which is a rather fraudulent scheme that occurs when the total cost of a prescription drug to an insurer or pharmacy benefits manager is less than a patient’s co-pay, the pharmacy benefits manager keeps the difference.

Who does the pharmacy benefits manager work for?

Themselves. They are a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), and state government employee plans. They essentially are independent mediators between pharmacies, insurance companies and drug companies.

“According to a March 2018 report issued by the University of Southern California’s Schaeffer Center for Health Policy & Economics based on the Center’s analysis of 2013 data from a large commercial insurer combined with data on national average drug reimbursements, 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 over-payments were more likely to occur on claims for generic drugs than brand drugs and that the total over-payments in the Center’s sample amounted to $135 million.”

A fraud of pennies quickly adds up to millions, and the pharmacy benefits managers probably thought no one was watching. A fraud so obvious that even the Republicans couldn’t defend it.

WHERE IS THE BILL NOW? Waiting to be placed in a Senate Committee.

DEMOCRATIC SPONSORS – Bennett, Sokola, Bentz, Dorsey Walker, Heffernan, Jaques, Kowalko, Seigfried, K.Williams

REPUBLICAN SPONSORS – Delcollo, Pettyjohn, Wilson, D.Short

YES VOTES – Baumbach, Bennett, Bentz, Bolden, Brady, Briggs King, Bush, Carson, Chukwuocha, Collins, D.Short, Dorsey Walker, Dukes, Gray, Heffernan, Hensley, Jaques, K. Johnson, K. Williams, Kowalko, Longhurst, Lynn, Matthews, M.Smith, Minor-Brown, Mitchell, Morris, Osienski, Postles, Q. Johnson, Ramone, Schwartzkopf, Seigfried, Shupe, Smyk, Spiegelman, Vanderwende, Viola, Yearick


ABSENT – Cooke, Dorsey Walker, Griffith

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