Blake Gillman, owner and CEO of George’s Pharmacy and Medical Equipment, was recently featured in a segment by CBS4 out of Indianapolis where he discussed how the way prescription drug prices are negotiated.

Many independent pharmacies are being negatively impacted due to these negotiations. The state is currently working on legislation to aid these pharmacies.

In an article by Kayla Sullivan CBS4, Gillman is quoted as saying, “Independent pharmacies are either closing up or they are selling to one of the big boys.”

According to Gillman, this is due to hidden prescription price negotiations that are set by Pharmacy Benefit Managers (PBMs). A PBM manages prescription drug benefits on behalf of health insurers.

As of December, states were officially allowed to regulate PBMs after a ruling was approved by the Supreme Court. The United State Supreme Court declared in Rutledge v. Pharmaceutical Care Management Association that states do have the ability to pass legislation that requires PBMs to reimburse pharmacies for drugs at a rate equal or higher than the pharmacies’ wholesale cost. According to pharmacytimes.com, this clears the way for states to pass laws that protect pharmacies from predatory reimbursement practices by PBMs.

That said, there are Indiana Senate and House bill proposals that also encompass PBM regulations; these include SB 143, HB 1393 and SB 62.
SB 143: Pharmacy benefit managers. Adds requirements of pharmacy benefit managers when denying an appeal of the maximum allowable cost pricing of a prescription drug. Requires the department of insurance to develop a process for complaints regarding pharmacy benefit managers, including: (1) denied appeals of maximum allowable cost pricing; and (2) unfair, unjust, or unlawful contract provisions.

HB 1393: Pharmacy benefit managers. Prohibits the inclusion of certain provisions in a contract between a pharmacy benefit manager and an entity authorized to participate in the federal 340B Drug Pricing Program. Provides that a pharmacy benefit manager's violation of the prohibition is an unfair or deceptive act or practice in the business of insurance.

SB 62: Prescription drug rebates and pricing. Provides that the defined cost sharing for a prescription drug under a policy of accident and sickness insurance or a health maintenance organization contract must be calculated at the point of sale and based on a price that is reduced by an amount equal to at least 85% of all rebates received by the insurer or health maintenance organization in connection with the dispensing or administration of the prescription drug.

The segment including Gillman can be viewed at: https://cbs4indy.com/news/indiana-lawmakers-want-to-regulate-the-drug-pricing-process/.