News / Utah / 

Ivy Ceballo, KSL

Utah prescription costs: Lawmaker pushes bill targeting 'medicine mafia'

By Paul Nelson, KSL Newsradio | Posted - Feb. 11, 2020 at 11:10 a.m.



SALT LAKE CITY – One lawmaker says there’s a "medicine mafia" keeping prescription costs higher than they need to be. He’s introducing a bill that could force certain companies to give money back to consumers.

Rep. Paul Ray, R–Clearfield, says many people may be pointing the finger of blame at major pharmaceutical companies when it comes to drug prices going up. However, he says there are other companies that are inflating prescription costs, and Ray says they’re doing so to make themselves rich.

Pharmacy Benefit Managers, or PBMs, used to do a lot of good work, according to Ray. He says they buy medicines from drugmakers in bulk then negotiate a price with individual pharmacies, plus they can arrange for customers to get rebates out of big pharmaceutical companies. In the beginning, Ray says they helped consumers get a better deal than they would have been able to get on their own. However, over time, he believes PBMs developed a stranglehold on drug manufacturers and started raising rebates just so they can keep part of that money.

Ray says, "I asked some of the pharmaceutical companies, 'Why don’t you just tell them, no, we’re not going to participate?' The answer is: 'If we do that, we’ve been told, point blank, that the PBMs would not buy any of our medications and put us out of business.'"

His HB272 is reportedly getting secret support from drugmakers, but he says they can’t publicly announce this out of fear of retaliation from the PBMs.

“They will take major financial hits from the PBMs for supporting what we’re doing. They support it,” Ray says.

The bill would require insurance companies to publish the total value of the rebates they get from a PBM, plus it would make major changes to what the PBMs are allowed to do with that money.

Ray says, "They don’t get to keep it. They have to share it with the consumer. Right now, that’s not happening. The consumer gets zero out of that rebate."

Ray has been researching this legislation for two years. He accuses some of these companies of playing dirty and intimidating people who speak out about it. He claims his prescription was canceled in 2018 after he demanded these companies be audited. He says it happened again last June.

"I posted on Facebook and talked about how the DOJ and the FTC are ready to investigate antitrust issues. Four days later, I get a notice that my prescription is canceled, again," he says.

He hopes that if the PBMs lost their control of these rebates, the overall costs of the medications will go down.

Paul Nelson

KSL Weather Forecast