On February 19th, the Governor’s Task Force on Reducing Prescription Drug Prices met in Oshkosh to hear from the consumer, insurance, PBM, and self-insured employer perspectives.
At the outset of the meeting, Deputy Commissioner Nathan Houdek, who is heading the Task Force, noted that the Task Force has not developed any recommendations yet, but rather is identifying topics of discussion.
The meeting started off with two personal stories. The first came from a business owner in the Oshkosh area who was diagnosed with diabetes and has struggled to cover the cost of insulin. The second story came from a mother whose son was recently also diagnosed with diabetes, and she detailed their family’s struggle with keeping up with the cost of her son’s treatments.
Next, Kris Hathaway of AHIP and Heather Cascone of PCMA gave a joint presentation. Ms. Hathaway walked the Task Force through the prescription drug supply chain and discussed the value PBMs can offer to insurers, including how PBMs aggregate purchasing power to lower costs. Ms. Cascone then detailed why PBMs are utilized and exactly what services they offer. She also identified PBMs as having a relatively small percentage of the overall prescription drug supply chain.
After that, Don Nelson of Magellan Rx presented on how Magellan specifically works as a pharmacy benefit administrator for several states in their Medicaid programs. Of note, Wisconsin has its own carved-out tool for Medicaid. He also identified predicted Medicaid prescription drug spending trends, detailed in Magellan’s Rx Management Medicaid Trend Report.
Last to present was The Alliance, some of its members, and National Cooperative Rx, it’s PBM purchasing coalition. COO Paul Meyer gave a history of The Alliance and an overview of what it does, highlighting its focus on high quality, affordable care through group purchasing. Then, member employers expressed their experiences with managing healthcare costs generally, but also prescription drug benefits specifically. All three member employer representatives called-out their on-site clinic as one of the ways they deal with keeping costs under control. Finally, Josh Bindl of NCRx discussed their work as a PBM purchasing cooperative, and how one of the main concerns of employers is the approaching increase in pharmacy benefit costs from specialty drugs and gene therapies.
The day ended with discussion amongst the Task Force regarding policy ideas identified in the attached document. These included transparency, restrictions on PBM contracting, and discount models.
Deputy Commissioner Houdek noted that the Task Force will not be weighing in on the PBMs bills currently in the legislature (SB100/AB114). The next meeting will be on March 18th in Wausau at the Northcentral Technical College Professional Conference Center Room (1004A/B) and will be focused on pharmacies and pharmacists.