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Strides Made Toward Increasing PBM Transparency in Ohio

posted: May 20, 2019

There are two PBM transparency bills in the legislature this year. One bill that has gained traction in the House is HB 63, The Prescription Drug Co-pay Integrity Act, sponsored by Rep. Scott Lipps (R) and Rep. Thomas West (D), which provides clawback protections for patients. “Clawbacks” are tools used by PBMs to over-inflate the cost of prescriptions for patients at point-of-sale transactions.

House Bill 63 mandates that insurers cannot prevent pharmacy employees from discussing all prescription cost options with their customer, even when that discussion involves informing a patient that they can purchase the prescription at a lower cost without their insurance. The Prescription Drug Co-pay Act also prohibits a health plan or PBM from directing a pharmacy to charge a patient an amount greater than the pharmacy’s cash price for the prescription, or an amount greater than the net reimbursement.

Several hearings were held in the spring on HB 63. OAR wrote letters of support to all committee members and filed official, written testimony into committee record. Ultimately, the bill’s language ended up being inserted in the budget package which was passed by the House the second week of May. The Senate is expected to vote on the package in the coming weeks.

OAR will be carefully monitoring the progression of the legislation.