Legislative Bill Watch

OHFAMA's Legislative Registered Lobbyists are:

Dan Leite, Capitol Advocates
Courtney Saunders, Capitol Advocates 
Jimelle Rumberg, Ph.D., OHFAMA Executive Director


HB 479  Ohio Prescription Drug Co-Pay Integrity Act

OHFAMA signs on to assist the Ohio Pharmacy Association’s legislation

Reps. Scott Lipps and Thomas West formally introduced HB 479, dubbed the Ohio Prescription Drug Co-Pay Integrity Act yesterday at the State House.
To view the press conference in its entirety, visit: https://www.ohiochannel.org/video/press-conference-discussing-prescription-drug-legislation

Prescription Drug Co-Pay Integrity Act

Issue:  Clawback is a tool Pharmacy Benefit Managers (PBM) use to over-inflate the cost of prescription medications at the point-of-sale transaction. Essentially, a PBM clawback forces some pharmacies to charge customers more than the pharmacy’s cash price. The PBM then “claws back” the money the patient was overcharged.    Another practice used by PBM’s is gag restrictions. A contractual gag prevents pharmacy employees from discussing all prescription costs with their customer. 

Solution:  The Prescription Drug Co-Pay Integrity Act will improve Ohioans access to prescription medications by:
1.) Prohibiting a health plan or PBM from directing a pharmacy to charge a patient an amount greater than the pharmacy’s cash price or the net reimbursement to the pharmacy. This ensures that regardless of any co-pay gimmicks, the patient will pay the lowest possible amount at the pharmacy counter.

 2.) Prohibiting a health plan or PBM from forcing a pharmacist to remain silent when it comes to the financial details and options when it comes to their patients’ medications.

Fast Facts:
• The practice of clawbacks and gag restrictions have been witnessed in every state and has resulted in more than a dozen lawsuits across the country.

  • Most people believe that their co-pay is their portion of a shared payment with their insurance company for a particular medical or pharmacy service. However, a clawback is when the patient pays for the entire cost of the service, and an extra hidden payment to the insurance company’s PBM middleman. A news reporter in New Orleans dubbed this as not a co-pay; but instead, it’s a “you-pay.”
  • The legislation will ensure that patients are getting the best deal possible at the pharmacy counter and ensures that patients aren’t in the dark on PBM drug pricing shell games. A recent analysis by a mid-sized pharmacy chain in Ohio found hundreds of clawbacks in the last three months, with 50 of them meeting the “double trouble” standard of the pharmacy losing money on the transaction, as well as a PBM clawback equal or greater than $10.
  • Most clawbacks are relatively small, ranging from a few cents to $5-7 in most cases, but there are many transactions where patients are overcharged by more than $20. Some of the most egregious clawbacks occur in Medicare Part D, where overinflated co-pays not only pinch patient’s wallets, but they also race patients into different deductible phases, which has been found to cost taxpayers billions of dollars. http://www.ncpanet.org/newsroom/newsreleases/2017/09/28/study-finds-medicare-'dir-fee'-legislation-would-save-government-billions   

Ohio Prescription Partnership includes:  Alliance for Transparent & Affordable Prescriptions  American College of Rheumatology  Cancer Support Community of Central Ohio  Cleveland Clinic Coalition of State Rheumatology Organizations  Epilepsy Foundation Greater Dayton Region Genoa, a QoL Healthcare Company Global Healthy Living Foundation  National Alliance on Mental Illness Ohio  National Community Pharmacists Association National Multiple Sclerosis Society National Psoriasis Foundation Ohio Association of Rheumatology Ohio Bleeding Disorders Council  Ohio Foot & Ankle Medical Association Ohio Hematology Oncology Society Ohio Osteopathic Association Ohio Pharmacists Association The Academy of Medicine of Cleveland & Northern Ohio U.S. Pain Foundation


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