Iowans should pay no more than is absolutely necessary for their medicines.
It’s time to modernize our healthcare system to lower out-of-pocket costs.
It’s time for the PBM Accountability Project of Iowa.
WHO WE ARE
The PBM Accountability Project of Iowa is comprised of the Iowa Pharmacy Association, the Iowa State Grange, EasterSeals Iowa, Prevent Blindness Iowa, the Iowa Academy of Family Physicians, the Rheumatology Association of Iowa, the Iowa Osteopathic Medical Association, American Free Enterprise Chamber of Commerce and other stakeholders working to help ensure that Iowans aren’t overpaying for the prescription medicines they need. We are educating our fellow Iowans about the role Pharmacy Benefit Managers (PBMs) play in manipulating prescription drug prices and identifying solutions to return savings to patients, employee health plans, and taxpayers.
We are committed to finding meaningful reforms in the drug pricing system to minimize waste and ensure Iowa patients, families, and communities can afford their medications.
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Together, we are:
Educating stakeholders about the ways PBMs profit
Presenting effective, patient-oriented policy solutions
Helping Iowa patients, pharmacists, employers, and taxpayers pay a fair price for prescriptions
THE PBM PROBLEM
Iowa’s local pharmacies are being forced out of business, patients and families continue to face high out-of-pocket costs for healthcare, and taxpayers risk footing the bill. Meanwhile, Pharmacy Benefit Managers - or PBMs - are profiting.
PBMs are companies that manage the prescription drug benefit for public and private health insurers. PBMs were meant to give patients and purchasers leverage when negotiating prescription medicine prices. However, these multi-billion-dollar corporations fail to pass the savings they negotiate on to the patients, employee health plans, and the public insurance programs that pay the final price.
Currently, just three PBM corporations control more than 80% of the U.S. market share. These three PBMs controlling the market are all vertically integrated with major health insurers and affiliated pharmacies to virtually eliminate competition from small, mom & pop pharmacies. They even use overseas entities to manipulate prescription drug prices.
A growing number of states have found that they’ve been overcharged by PBMs to the tune of hundreds of millions of dollars. These overcharges will continue to occur if we don’t address the many games PBMs play at Iowans’ expense.
Iowans are taking note - more than 80% of Iowa likely voters believe it is important to have rules that require PBMs to deliver value and lower drug costs for patients.
And we’re ready for meaningful policy changes…
SOLUTIONS FOR IOWA
PBMs are causing a serious strain on Iowans across the state, from patients who cannot afford the exorbitant costs of their medications to family-owned pharmacies that simply cannot compete with the billion-dollar companies forcing them out of the market. Iowa leaders like Senator Grassley and Rep. Miller-Meeks have introduced bipartisan legislation to regulate these middlemen at the federal level and we’re working to identify more ways to return savings back to Iowans.
One of the most promising and innovative solutions to lower out-of-pocket cost for prescriptions is through a “PBM Reverse Auction,” which helps transform the opaque and uncompetitive process for setting prescription drug prices into a transparent, dynamically competitive marketplace where PBMs would compete with one another for the state of Iowa’s business.
In order to preserve choice and competition among pharmacies in Iowa communities that lowers the costs Iowans pay at the pharmacy counter, Iowa’s PBM reverse auction should mandate that qualified PBM bidders conform to the following requirements:
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Qualified pharmacy benefits manager bids shall utilize the Iowa Average Acquisition Cost methodology for pharmacy ingredient cost reimbursement of all covered drugs.
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Qualified pharmacy benefits manager bids shall utilize a reasonable pharmacy dispensing fee, which the department shall establish for the first pharmacy benefits manager reverse auction. An actual dispensing fee shall be established for subsequent pharmacy benefits manager reverse auctions within the ranges determined by a cost-of-dispensing survey which the department shall perform periodically and which all participating pharmacies shall be required to complete.
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No health plan participant covered by pharmacy benefit manager services procured in accordance with this section shall be prohibited from filling a prescription drug order at any pharmacy located in the state provided that the pharmacy accepts the same terms and conditions as the pharmacies participating in the covered person’s health benefit plan’s network.
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With the exception of incentives in value-based programs established by a health carrier or a pharmacy benefits manager to promote the use of higher quality pharmacies, a qualified pharmacy benefits manager awarded a services contract in accordance with this section shall not impose different cost-sharing or additional fees on a covered health plan participant based on the pharmacy at which the covered health plan participants fills their prescription drug order.
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A qualified pharmacy benefits manager awarded a services contract in accordance with this section shall not require a covered health plan participant, as a condition of payment or reimbursement, to purchase pharmacy services, including prescription drugs, exclusively through a mail-order pharmacy.
There are many other policy solutions that could hold PBMs accountable to their promise to lower out-of-pocket costs. Iowans support several policy provisions to regulate these middlemen, including:
Requiring PBMs to get the best possible deal for health plans, which would lower patients’ costs
87% support
Changing how PBMs profit so it’s not connected to the price of prescription drugs and they are not incentivized to drive up prices for patients
84% support
Requiring PBMs to pass discounts along to patients that they get from negotiating with prescription drug manufacturers
85% support
Introducing more transparency into PBMs’ contracts and the prescription drug pricing process
86% support
We will continue working together to identify the best solutions for all Iowans.