Bipartisan bill targets prescription drug costs in Wisconsin: ‘Every day patients tell me they struggle’
MADISON — An effort to lower prescription drug costs and increase access to neighborhood pharmacies in Wisconsin gained Republican supporters Tuesday as pharmacists urged passage of the bipartisan measure that has previously been opposed by insurance companies and the state chamber of commerce.
The bill is part of a growing call nationwide to do something about rising prescription drug prices. A lack of transparency has created a system in which drugmakers, middlemen called pharmacy benefit managers and other health care providers all benefit from increasing prices.
The new proposal targets pharmacy benefit managers, a critical part of the distribution and sales chain between manufacturer and consumer. They bargain drug prices on behalf of insurers and employers, manage plans and process claims. But most of their work and terms of the agreements they reach are hidden to people buying prescriptions.
Rebates paid to middlemen help assure favorable treatment for a medication on an insurer’s list of covered drugs and help keep premiums lower. But the rebates are not passed on to consumers who use the particular medication, and they can face high copays based on the drug’s list price, not the discounted one.
The bill introduced Tuesday would prohibit gag clauses in pharmacy benefit managers’ contracts that ban pharmacists from telling patients about lower-cost options. The proposal would prohibit charging patients a higher copay than the cash price of their medication. It would also bar pharmacy benefit managers from requiring a patient to pay more to purchase prescriptions at their local pharmacy than from mail order.
Republican Senate President Roger Roth of Appleton said he was convinced to get behind the measure after speaking with pharmacists concerned about the rising costs and the role that benefit managers play in setting prices.
“This is an area where you have Republicans and Democrats who have come together,” Roth said. He was joined by pharmacists and Democratic Sen. Jon Erpenbach and Rep. Debra Kolste, also a Democrat, at a Capitol news conference to unveil the bill. GOP Rep. Michael Schraa is also a co-sponsor.
Wisconsin would join 33 other states that have some form of regulation for the industry if the measure passes and is signed into law by Democratic Gov. Tony Evers. Kolste said she had spoken with Evers about the bill and he was supportive.
Evers’ spokeswoman Melissa Baldauff was noncommittal, saying in a statement that “the governor is committed to making healthcare more affordable and accessible for all Wisconsinites, and is always encouraged to see proposals with bipartisan support.”
A similar bill introduced in 2017 had only Democratic co-sponsors and did not get out of committee. Opponents include Wisconsin Manufacturers and Commerce, the Alliance of Health Insurers, America’s Health Insurance Plans, CVS Health and WPS Health Insurance.
Wisconsin Manufacturers and Commerce spokesman Nick Novak declined to comment.
The Pharmacy Society of Wisconsin is among the bill’s supporters. Nick Olson, a pharmacist and chairman of the society’s board, said the measure would have a “real, meaningful impact” on patients.
“Every day patients tell me they struggle to afford their medications and many others, whom I may never hear from, choose to go without,” Olson said.