MN Legislates the PBMs

Yesterday…right at the end of session…

Video of the session below.

From the cited story.

  • PBMs must submit annual reports to the department and disclose rebate and pricing information. They must also notify health plans if an activity presents a conflict of interest.

PBMs have aggressively defended their ability to conceal their pricing methods from patients and regulators. I’ll be curious to see how they respond to this changed playing field in Minnesota. I’ll be rooting for this change to take hold and spread across the country. I expect, however, that the PBMs will push back and send this issue into extended legal contention.

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Any thorn in the side of that PBM racket is a good thing.

That whole PBM racket is the ‘parasite economy’ in action. These people who take instead of producing things.

Compare PBMs and their cronies to tapeworms and ticks. Like parasites in nature, the ticks on the medical system don’t want to kill the host organism—meaning us. It’s in their interest to keep the host alive so they can keep eating our food and sucking our blood.

They have this artificially inflated “list price” then these creeps expect you to be grateful for a “rebate”

All this complicated bull, thousands and thousands of people getting fat paychecks to sort out the crap they themselves create but in the end they contribute nothing to the world.

Express Scripts had 2016 revenues of $100.752 billion.

100 billion sucked out of the hosts.

Did you watch the hearing? The representative from near Lakeville cries. I’m watching it now.

I saw that part. I also saw the ‘snakes in suits’ opposing the bill. The second dude speaking using all these lawyer words to explain why he is voting against and you can see the guy in front of him with a what the heck look on his face. Stop with the fancy words you snake just say the industry financed your political campaign, bought your vote and your backing them.

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It’s unclear to me how this bill helps lower prices for patients at the pharmacy counter. What am I missing?

They are going after the Pharmacy Benefit Managers. Its an attack against high drug prices across the board. Its a stab at the system. The system will find another way, but its a start. Pharmacists are no longer restricted from telling patients about cheaper options.

Next, they have to go after the insurers. The Feds are working over the manufactures.

Holy cow, I just looked it up. Every time I come to this forum I learn more and more how crooked and corrupt that system is.

“I can’t tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high co-pay,”

I would have just done it anyway. Its not breaking real law its just a workplace rule.

I’m gonna say congratulations because y’all got the bill thru, but at first glance I don’t see any teeth in it.

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It passed by alot. Was that the final vote ?

@IgotT1, You posted the House of Reps vote. It passed the House - Passed 87-42. Mine voted against it, which is super frustrating because I went in to talk to her.
I believe 2 people voted against it in the senate. So, maybe 65 voted for it.

Here’s a video summary about PBMs: HERE
They mention the big three. We have ExpressScripts and a large Optum/United Health corporate office. So, we must have been a good place to haul them in to testify. Looks like CVS CareMark is in Rhode Island.

I have a stack of paperwork over an inch thick that they gave me last time I went in to see the PBMs testify. In the interest of brevity, I just scanned the 2nd engrossment and uploaded it here for you. (I know this stuff is an absolute pain to find on the internet.) Note: I just had a paper copy of the 2nd version sitting next to me. The Senate passed the 5th engrossment. The farther along we get in the version numbers, the harder it is to read. So, hopefully this is a decent summary of the basics. I still cant use the gov bill tracker software well. I find it easier to just show up in person and get the stack of paperwork, sit down, and start reading it.

House bill 728 PBMs.docx (72.6 KB)

Note: We were lucky to get anything through at all. It was days before the end of session. I expect some re-writes next year. This year has been a cluster-F. It passed in omnibus. Senate and the House refuse to do biz with one another. Controlled by different parties.

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Thanks. I still hope I’m missing something.

It seems as though the biggest deal here is the requirement to have an adequate network of pharmacies in place and PBMs can’t include their mail-order arm as part of the network. To me, this may mean that PBMs will need to negotiate better deals with local, independent pharmacies. While that’s probably good for the local pharmacies and the communities they serve, it’s not clear how that will result in lower consumer prices.

The gag clause removal has already been done on the federal level, so to the degree that this legislation closes some MN-based loophole, that’s good.

The other unknown is the “fiduciary responsibility” part, but again, it’s not clear how that will drive lower consumer prices, since the responsibility is to the plan sponsor (that’s where most rebates go today).

Overall, I think my earlier statement stands, unless it’s replaced with, “m’eh!”

I appreciate your feedback on it. I’m not sure what they are up to. I know the PBMs are super pissed. So are the large insurers. They were coming in from all over during the hearings to watch them as a group on the big screen.

I, personally, felt like they wrote something super open ended. Its hard to know how something like that plays out. I think thats on purpose, not because they didn’t have time. This was a move. Now, they wait for a counter move. Then, they make another move - like what happened with the Feds and the cheap Humlaog. Thats my best guess. I dont think they lay all the cards on the table at once. I think there are a lot of players in this game. My guess is that this is just how long term legal battles go. Move - countermove - move, etc. Its slippery. Its taken years to get to this point. Things are starting to move, though, if legislation is starting to pop up. Might still take years.

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So true! Thanks for the reminder that we need to keep working for perfection, even if we can never actually get there.