During the eighth week of the 2020 legislative session, the Georgia House of Representatives passed bills that we hope will help remedy the rising cost of prescription drugs.
House Bill 946, which I co-sponsored, builds on last year’s “anti-steering” legislation that prohibits insurance companies from forcing patients to use their company-owned pharmacies. Georgia was the first state to pass such a law.
Unfortunately, insurance companies found a way around that 2019 law by simply informing patients that if they got their medications filled at an out-of-network pharmacy, they would get zero coverage of the cost.
This is a pretty clear indication of one of the primary causes of rising health drug costs: Health care decisions being made by major corporations focused on profits instead of by physicians and pharmacists whose main concern is patient care.
Major insurers actually own "third-party" Pharmacy Benefit Managers that direct and pay for prescription drugs. The insurers also own specialty pharmacies, mail-order pharmacies and even some brick-and-mortar pharmacies.
This vertical integration of every component of the pharmaceutical supply change is forcing out smaller independent pharmacies. But as we see every day, without a transparent, free-market system, drug co-pays are becoming out of reach of more and more Georgia families.
HB946, if signed into law, would do the following:
•Ensure physicians are utilized in the development or management of drug formularies currently developed by Pharmacy Benefit Managers (PBMs) to dictate which drugs are covered and what they will cost.
•Require PBMs to report whether their drug prices are above or below public pricing benchmarks that indicate the actual cost of drugs being sold.
•Require PBMs to apply all drug discounts or co-pay assistance by third parties to patients’ out-of-pocket maximums each year.
•Prohibit the practice of “spread pricing” in which PBMs mark up the cost of generic drugs in Medicaid plans but underpay pharmacies for those drugs and pocket the difference.
Also on March 4, the House passed HB 918 to amend “The Pharmacy Audit Bill of Rights” to limit the size and frequency of pharmacy audits used by PBMs to recapture money from pharmacies around the state. As a colleague aptly noted, the PBMs typically audit more expensive drugs to get more money back from pharmacies.
The third bill passed last week — HB 947 — would direct the Georgia Department of Community Health to initiate an independent actuarial study of the potential cost savings of carving out of our state Medicaid managed care plans the pharmaceutical benefits. Instead of paying a flat per-person fee like we do now, the study will show whether we should return to the traditional fee-for-service method of paying for drugs. This bill also would give Medicaid patients the freedom to choose their pharmacies without penalty.
Through these three bills — and last week’s actions regarding surprise billing — we hope to bring clarity and fairness to the cost of health care in Georgia.
Thank you for the opportunity to represent District 116. If you have any questions or concerns, feel free to contact me at 404-463-2245 or at firstname.lastname@example.org. May God bless you and your family, this wonderful county, and our great state.