(The Center Square) – Illinois lawmakers continue to push for more regulatory control of pharmacy benefit managers, or PBMs.
PBMs act as third-party “middlemen” who negotiate the price pharmacies and insurance companies pay for prescription drugs from the manufacturers. Their role is supposed to involve negotiating the cost of drugs to save patients money, but critics contend they are actually driving costs up.
The U.S. Department of Health and Human Services reports between January 2022 and January 2023, more than 4,200 drugs saw a price increase on average of more than 15%.
Gov. J.B. Pritzker recently took part in a roundtable discussion on the topic of PBMs and called for the passage of the Prescription Drug Affordability Act.
“It is going to take aim at the common ways that PBMs game the system to profit at the expense of Illinois families and employers,” said Pritzker. “Many of those employers that are really deeply, negatively affected are small and medium-sized businesses.”
If passed into law, the legislation would create an independent Prescription Drug Affordability Board. The board could set upper limits on what people would pay for their medications.
There has been a national movement for more PBM regulation. The Trump administration is taking steps to meet with pharmaceutical companies to examine PBMs and discuss reforms to possibly eliminate PBMs.
Conner Rose with the Pharmaceutical Care Management Association said a study by the Federal Trade Commission looked favorable on PBMs.
“Specifically, PBM ownership of mail order pharmacies which, the study demonstrated that PBM ownership of mail order pharmacies actually do provide value to consumers in the form of lower drug costs,” said Rose during a committee hearing last year.
Some drug manufacturers contend that it’s expensive to develop new drugs and run the required clinical trials.