Pension & Benefits News Wisconsin Governor's prescription drug task force hears employers' and insurers' perspectives on role of PBMs
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Friday, March 20, 2020

Wisconsin Governor's prescription drug task force hears employers' and insurers' perspectives on role of PBMs

By Pension and Benefits Editorial Staff

The Wisconsin Governor's Task Force on Reducing Prescription Drug Prices met in Oshkosh recently to understand and discuss how insurers and employers are managing increasing prescription drug costs, including the role pharmacy benefit managers (PBMs) have in that process.

The meeting included presentations from Wisconsin businesses and health benefit cooperatives as well as associations representing PBMs and insurers. The session marked the task force's third monthly meeting since it first launched in November 2019.

“Today's meeting provided valuable insights into the challenges insurers and employers face in managing prescription drug costs for enrollees and employees," said Task Force Chair and Deputy Insurance Commissioner Nathan Houdek. “We learned about a few of the tools currently used to manage prescription drug costs, including the role that PBMs play in that process. In the coming months, the Task Force will continue examining the roles of the various stakeholders in the prescription drug supply chain in order to develop solutions to drive down prescription drug costs for consumers."

The task force heard presentations from the Pharmaceutical Care Management Association (PCMA) and America's Health Insurance Plans (AHIP) about PBMs and the pharmaceutical market. Representatives from organizations such as The Alliance, Advanced Laser, National CooperativeRx, and Seats Incorporated discussed the cost of prescription drugs from employers' perspectives.

"PBMs are the advocates for 266 million consumers in the fight to keep prescription drugs accessible and affordable," said Heather Cascone, Senior Director, State Affairs, for PCMA. “Using advanced tools to manage pharmacy benefits, such as negotiating price concessions from drug manufacturers, offering patient care management programs and services to improve patient adherence to prescribed medications, encouraging the use of generic drugs, managing high-cost specialty medications, and offering more affordable pharmacy channels, PBMs are achieving an overall stable drug trend for prescription drug costs and helping patients live higher quality and healthier lives."

“Our member companies self-fund their health plans, which means they don't purchase health insurance. They pay for the services directly and take on the financial risk, which allows them to have more direct control over how their health benefits work, including the prescription benefits, to meet their employees' needs," said Paul Meyer, chief operating officer at The Alliance. “Employers are paying the vast majority of the costs of their employee health care plan and are innovating in various ways, including pooling their purchasing power by joining buying groups, to respond to ever-increasing drug costs and provide the best benefits."

“Patients who are accessing care through employer self-funded plans make up a significant portion of the healthcare marketplace," said Josh Bindl, chief executive officer of National CooperativeRx. “Employers care deeply about providing robust benefit plans that meet the needs of their workforce. Often patients do not have complete information on best drug at the best price and a well-designed employee benefit plan can help steer them to the highest value prescription drug option."

In August 2019, Gov. Tony Evers signed Executive Order No. 39 establishing a task force on reducing prescription drug prices. Throughout 2020 this group will analyze information relating to the development, pricing, distribution, and purchasing of prescription drugs; review actions already taken by Wisconsin and other states to reduce prescription drug prices; and identify opportunities to coordinate with other states and the federal government. Ultimately, the group will recommend potential actions that can be taken to reduce prescription drug prices in Wisconsin.

The task force is next scheduled to meet March 18 in Wausau.

SOURCE: https://oci.wi.gov

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