Bipartisan group of Virginia lawmakers target PBM reforms

RICHMOND, Va. (WRIC) -- A bipartisan group of Virginia lawmakers is taking on pharmacy benefits managers, known as PBMs. 

“When you’re talking about rebates, pharmacy prices, how drugs are priced, how they’re paid for, and such forth, complexity and confusion really comes to mind. It’s a very opaque system where nobody really understands it,” said Delegate Otto Wachsmann (R-Sussex), a pharmacist himself.

Wachsmann said these so-called middlemen often force drug manufacturers to pay them (typically through rebates) to ensure that their drug is covered by insurance companies. However, Wachsmann said that forces drug manufacturers to raise their prices to cover the added cost, which is passed on to consumers. 

“To me, that is the reason our prescription drug prices are so high because our third-party payers, the PBM, demand such high rebates from the pharmaceutical industry, and with that increased rebate the manufacturer has to pay, they have to get their money for those rebates, so they ended up raising the prices,” explained Wachsmann.

Bipartisan bills working their way through the General Assembly would require PBMs to pass along those extra fees (rebates) paid by drug manufacturers, which lawmakers say will help lower prescription drug costs. 

“That rebate money has to be shared back with cost share, that means it helps lower the copays the patients pay and helps to lower some of the premiums as well too,” Wachsmann said.

8News reached out to the Pharmaceutical Care Management Association, which calls itself “the national association representing America’s pharmacy benefit managers," to ask them about the legislation working its way through the legislative process, but didn’t hear back.