MPA | Pharmacy News

Testimony for HB 4348 was heard by the Michigan House Committee on Health Policy on Wednesday. The bill, which was introduced by Rep. Julie Calley in February, would require Pharmacy Benefit Managers (PBMs) to be licensed and regulated in Michigan.

Representative Calley explained what PBMs are to the committee on Wednesday, while also giving reasons for why she believes they need to be regulated:

“There is a middleman that many of us are not aware of [in pharmacy]. Certainly, our constituents are not.

So let’s say your beloved aunt goes to the doctor and it’s determined that they need another prescription. Most of us assume that when that script is presented to the pharmacy it’s the health plan who is determining what drugs are covered and at what cost. That’s actually not the case, what Americans pay at the pharmacy counter is determined by a complex opaque third party system.

The role of a PBM is to administer drug benefits for health plans, create and update [the] drug formularies process and pay pharmacy claims.”

Representative Calley notes that three PBM’s control 85% of the nation’s pharmacy market. The three are Caremark (a part of CVS Health), Express Scripts (Cigna) and OptumRx (United Health Group).

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