Bourne Supports Legislation to Regulate PBMs, Help Local Pharmacies

LITCHFIELD- State Representative Avery Bourne (R-Raymond) supported legislation to bring oversight to a largely unknown element of the healthcare industry, pharmacy benefit managers (PBM) which serve as middlemen and can drive up prescription drug costs.

Bourne stated, “At a time when prescription drug costs are skyrocketing, PBMs are consolidating and growing and yet we know little about their business practices here in Illinois. This legislation is a win for transparency, for consumers looking for more affordable choices, and for small pharmacies.”

A PBM is a third-party administrator of prescription drug programs for groups that pay for drugs, like insurance companies or state government employee plans. Currently the Illinois Insurance Code is very limited in regulating PBMs specifically. Their outsized role in the drug market compared to their limited regulation impedes efforts to reduce drug costs. Many small pharmacies and local pharmacists have pushed for increased transparency and regulations on PBMs.

House Bill 465 takes steps to monitor and regulate PBMs by requiring them to be registered and establishing contractual provisions between them PBMs and a health insurer. Further, the legislation will help patients seeking lower cost drugs by prohibiting PBMs from limiting the information a pharmacist can disclose, like more affordable options or requiring a customer to pay a co-pay when the retail price would be lower. In addition, the Department must provide a yearly report to the General Assembly and it requires a PBM to notify the Department of a conflict of interest, and provide certain disclosures.

“By actively regulating PBMs and increasing transparency not only between PBMs and pharmacists, but between pharmacists and customers, we can ensure that patients are not priced out of their care,” said Bourne.

HB 465 passed the Illinois General Assembly unanimously and awaits action by the Governor.