The Problem
The largest PBMs own mail-order or retail pharmacies, but they are also responsible for reimbursing the independent pharmacies that compete with their own pharmacies. As a result of this conflict of interest, PBMs use a variety of tactics to steer patients away from independent pharmacies and direct business to their own mail-order pharmacies, which often provide worse service for essential prescriptions. Patient steering tactics can be direct, like requiring that patients use the PBM’s pharmacy, or indirect, like using patient data to push patients toward their own pharmacies or ensuring that patients pay more to use an independent pharmacy than a PBM-owned one.
The Solution
Patients should have a free and fair choice of pharmacy, and independent pharmacies should be able to compete with PBM-affiliated pharmacies on a level playing field. State law should entirely prohibit PBMs from requiring patients to use their own pharmacy, and prevent PBMs from using patient data to steer patients and make them pay more to use another pharmacy.
Model Legislation
Georgia’s 2019 Pharmacy Anti-Steering and Transparency Act.[1]
Notes
[1] O.C.G.A. § 26-4-119.