AMCNO Supports Prescription Drug Co-Pay Integrity Act

The AMCNO attended a press conference held by Representatives Scott Lipps (R-Franklin) and Thomas West (D-Canton) to discuss the Prescription Drug Co-Pay Integrity Act (HB 479)—important new legislation that will address clawbacks taken by pharmacy benefit managers (PBMs). Clawback is a tool PBMs use to overinflate the cost of prescription medications at the point-of-sale transaction. Essentially, a PBM clawback forces some pharmacies to charge customers more than the pharmacy’s cash price. The PBM then “claws back” the money the patient was overcharged. PBMs also use contractual gag restrictions to prevent pharmacy employees from discussing all prescription costs with their customers. Clawbacks and gag restrictions have been witnessed in every state and have resulted in more than a dozen lawsuits across the country.   

This new bill will improve Ohioans’ access to prescription medications by prohibiting a health plan or PBM from directing a pharmacy to charge a patient an amount greater than the pharmacy’s cash price or the net reimbursement to the pharmacy. This practice ensures that the patient will pay the lowest possible amount at the pharmacy counter, regardless of any co-pay gimmicks. This legislation will also prohibit a health plan or PBM from forcing a pharmacist to remain silent when it comes to the financial details and options when it comes to their patients’ medications.

The AMCNO supports this legislation, and has become part of the Ohio Prescription Partnership, because it is an opportunity to do something on behalf of our patients to bring down the cost of prescription drugs. We will continue to follow this issue and report updates to our members.

For more information about HB 479, click here. To view photos from the press conference at the Statehouse where the new legislation was announced, click here.



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