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Assembly unanimously passes drug transparency bill

Empower Wisconsin | Feb. 19,  2020

By M.D. Kittle

MADISON — In an overwhelming show of unanimity, the Assembly on Tuesday passed a prescription drug transparency bill by a 96-0 vote.

AB 114, a compromise measure to license and bring more accountability to Pharmacy Benefit Managers (PBMs), now moves on to the Senate.

“Some of the best bills we pass in this chamber and we talk about in this building have a personal connection to all of us,” said Rep. Michael Schraa (R-Oshkosh), co-author of the reform bill.

Lawmakers have had plenty of stories to tell about how unannounced formulary (approved prescription drug lists) changes and PBM-mandated “gag orders” have hurt their constituents, their families, themselves.

Schraa has talked about the struggles of his wife and daughter, how sick they became, after they were made to change medicines because their prescription drugs that they were effectively taking were removed from the formulary.

Rep. Paul Tittl (R-Manitowoc) shared a similar experience. Tittl, who suffers from rheumatoid arthritis, said his arm will never straighten because of a plan-mandated change in medicine.

“I was forced to go on another medication, even though my doctor told me what would work for me,” he said, adding that his arm is now locked at a 30-degree angle.

An emotional hearing earlier this month featured scores of horror stories about the powerful prescription drug middlemen.

It’s a watered down version to be sure from AB 114’s original provisions — in response to pressure from health plan and PBM lobbies. Still, the bill requires the benefits managers to be licensed with the state Office of the Commissioner of Insurance and demands clearer consumer language on drug formularies. It implements “equitable” standards for PBM assessments and fees on pharmacies. And the bill codifies a federal law recently signed by President Trump that ends PBM “gag orders” on pharmacies, nondisclosure agreements that have driven up costs for consumers.

“We are never going to control anything until we have transparency. That transparency with PBMs is always at a roadblock,” said Rep. Debra Kolste (D-Janesville), who has expressed her disappointment about the stripping of some key protections during the long negotiating process.

But proponents agree, the legislation is a good “bite at the apple.”

“This is a great first start. I know folks in my district are going to benefit from this,” said Rep. Tony Kurtz (R-Wonewoc).

Speaker Robin Vos (R-Rochester) reminded his colleagues that PBMs were created to hold down rising costs. He said it’s important to balance the need for reform while making sure changes don’t negatively impact the marketplace and put employers out of business.

“Let’s thank the drug companies for what they do but also require more transparency,” the speaker said.

One of the driving forces behind the reform legislation is concern over PBM confidentiality agreements, or gag orders. In many cases, the agreements have forced consumers to pay more for medicines through their prescription drug plans than they would had they paid out of pocket. Just as concerning is the fact that just three health care-related companies control about 80 percent of the PBM market. Independent pharmacists testified en masse how those relationships are driving smaller drug stores and chains out of business.

Rep. Barbara Dittrich (R-Oconomowoc) said transparency will lead to greater competition, which will drive down prices.

The legislation ended up with 101 co-sponsors, a rare bi-partisan accomplishment in a state with such a pronounced political divide.

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