Senator sponsors bill to regulate pharmacy benefit managers

Columbia State Sen. Kurt Schaefer hopes the third time is the charm.

He is sponsoring new legislation to regulate pharmacy benefit managers and to put the brakes on practices such as step therapy.

Pharmacy benefit managers, or PBM TMs, are in business to help employers reduce health care costs.

"This industry has proven over the last decade their main concern is company profits, regardless of whether or not they deliver low costs to employers, Schaefer said.

Kurt Schaefer said PBM's routinely reroute prescriptions from local pharmacies to a mail order house they, themselves, own. He said they often switch prescriptions to different medicines, which may be less effective. And they practice step therapy, where they will only pay for a prescribed drug after a patient goes through a series of cheaper drugs.

"I don't think all PBM's are bad and I think there is a cost savings element to what they do, Schaefer said. But, for as regulated as every other aspect of healthcare is, this is completely unregulated aspect of it.

The PBM industry said it only gives employers what they demand, and save them big bucks through mail-order prescription protocols.

"We have found it is a more cost effective and, we think, a more convenient means by which people can get their prescriptions, Express Scripts Michael Harold said.

And the industry bristles at the implication that no one is looking over its shoulder.

"We're regulated by the boards of pharmacy in all fifty states, the insurance divisions and the secretaries of health and the FDA, Medco Health Solutions David Root said. So, the idea or the notion that we're an unregulated industry is, frankly, absurd.

The committee took no action on the bill, which sets new limits on PBM TMs.

The legislation has failed in the two previous sessions, and Schaefer acknowledged it is getting a late start in committee this year.