Ask your legislators to support HB 4548 for enhanced PBM regulations.
Pharmaceutical industry middlemen known as Pharmacy Benefit Managers (PBMs) play a significant role in driving up prescription drug costs and insurance premiums. Despite their influence in the pharmaceutical supply chain, PBMs have continued to operate with little oversight and transparency. PBMs take advantage of that by routinely engaging in practices that increase their profit margin at the expense of consumers, including:
- Spread Pricing – When a PBM charges a health benefit plan more than they pay a pharmacy for a prescription drug and pockets the “spread” (or cost difference) as profit.
- Consumer Steering – When a PBM “steers” (or directs) a consumer towards an outcome that produces more profit for the PBM at the expense of the consumer, such as by:
- Requiring or encouraging a consumer to use a pharmacy that is owned or controlled by the PBM.
- Requiring a consumer to pay more or full cost for a prescription if they choose to use a pharmacy that isn’t preferred by the PBM.
- Reimbursing a pharmacy an amount less than a PBM reimburses itself or an affiliate.
- Skirting Transparency Requirements – The extent to which PBMs engage in these practices is unknown because they try to get around reporting requirements, of which there are too few.
HB4548 would enhance PBM regulations to curb those practices and lower prescription drug costs for Illinois consumers.