Pa. auditor general continues push for transparency in drug pricing

Tony Romeo
March 17, 2019 - 4:00 am

Pat Loeb/KYW Newsradio

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HARRISBURG, Pa. (KYW Newsradio) -- Pennsylvania’s auditor general continues to sound the alarm about the role of pharmacy benefit managers in setting the price for prescription drugs, and the lack of transparency in the process.  

Auditor General Eugene DePasquale says ‘pharmacy benefit managers’ or ‘PBMs’ are the ‘middle people’ who negotiate with drug-makers and retailers to determine what drugs are in your insurance plan, and what the prices will be.

Often, he says, prices are set in a take-it-or-leave it fashion.

DePasquale told a House committee that under current law, a pharmacist cannot tell a customer that it actually might be cheaper to pay cash for a drug than to use their insurance.

“So, it may be more expensive for them to use their insurance and pay a higher co-pay,” he said. “Now, what other system would that even be remotely tolerated?”

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DePasquale says consumers can get that information, but they must know to ask for it.

He says the current situation is also squeezing independent pharmacies out of business. Driving the issue is that the money paid by the Commonwealth to pharmacy benefit managers nearly tripled over five years, to almost $3 billion.

But DePasquale says because PBM’s are paid through contracts with managed care organizations, under current law, he cannot audit that money.