It’s a new session in Madison

Do you know what a pharmacy benefit manager (PBM) is? You should — they’re controlling your healthcare. This is why I recently introduced Cole’s Act, legislation to reform PBMs and ensure your doctor, not corporations, controls your drug decisions.

Cole Schmidtknecht was 22-years-old when he went to the pharmacy for a routine pickup of his inhaler. Cole was shocked when he learned that the price had increased from $66 to $539.19. He had not been notified that the cost was changing. This put Cole in a position where he was forced to choose between paying his rent and getting his inhaler. Cole died days later from an asthma attack after delaying the inhaler purchase. Sadly, many Wisconsinites face the same decision Cole did after unexpected drug price increases.

But let’s back up. What is a PBM and why do they have so much power? In theory, PBMs are hired by insurance companies as middlemen to manage and negotiate better prices for patients’ prescription drugs. In reality? PBMs pocket savings meant for consumers, discriminate against local pharmacies, and dictate available drugs and their costs. The (not so) best part? 89 percent of drug claims are controlled by the three largest PBMs, which are part of Fortune 500 healthcare companies. These huge companies are vertically integrated, which means that they own every step in the process, including pharmacy chains.

What are the practical effects of PBMs having this much power? Local pharmacies face closure due to below-cost reimbursements. PBMs pocket money meant for groups that provide healthcare to underserved populations. PBMs can also mandate that you use a mail-order pharmacy. At a recent press conference announcing the new legislation, Josie French, Chief Pharmacist at Trig’s, said it best: “The impact PBMs are having on rural pharmacists is staggering. They dictate where prescriptions can be filled, what the pharmacy can charge, and what they will reimburse. There is not any leverage to negotiate; it is not a fair market.” The full vertical integration gives PBMs more control over your drug decisions than your doctor has, and also boxes out independent pharmacies.

My new legislation, Cole’s Act, will reign in the power of these PBMs. The legislation will preserve and increase access and consumer safety, lower drug costs, and increase transparency. We’re supporting local pharmacies so they can continue serving rural areas. We’re restricting when and how PBMs can change drug coverage to make sure that Wisconsinites are not put in a position like Cole was. We’re making sure PBMs can’t mandate that you use a mail-order pharmacy to ensure that you can keep talking to your pharmacist if you choose to do so. We’re making sure that money meant to provide services to low-income and uninsured patients isn’t pocketed by PBMs. And we’re making sure that drug discounts count against patient deductibles to lower out of pocket costs for consumers.

Your drug decisions should be made between you and your doctor, not you and a Fortune 500 company. I’m excited to work hard this session to pass Cole’s Act to protect patients and independent pharmacies in Wisconsin.  

State Senate President Mary Felzkowski can be reached through her office at [email protected].