Public Health Committee Focuses On Pharmacy Benefit Managers, High Costs

Sep 20, 2019

A public health committee charged with understanding high health care costs heard about pharmacy benefit managers, or PBMs, Thursday at the statehouse. 

PBMs administer prescription drug programs for health insurance plans large and small. The entities were designed to get the lowest drug prices for plans, but have recently come under fire as part of the high drug price problem. 

Sen. Victoria Sparks (R-Noblesville) is educated as an economist. 

"This is complex, this is convoluted and this is hard, right?" Sparks says. 

Testimony pointed to a confusing pricing structure and PBMs operating pharmacies as part of the problem. 

Nathan Gabhart founded TrueScripts to help navigate the PBM system. He says there is a lack of knowledge among employers who provide health plans. 

"The problem is that the clients don’t know they are signing the contract," says Gabhart.  

Rokita, a former Indiana congressman turned health care advisor with Apex Benefits, says employers that provide health care should be able to access claims data. 

"And what happens when you do that is you go from always looking in the rear view mirror at the last year and getting only part of the picture, to looking out the windshield to see what’s coming," says Rokita. 

Other solutions proposed during the testimony included better patient protection from drug pricing changes. 

The committee will meet again next month.

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