Will legislature tackle prescription cost reform?

According to the Legislative Research Commission, before we can buy the medicine, insurance companies and pharmacy benefit managers negotiate prices with pharmaceutical companies.

Those companies provide rebates to the insurance companies to reduce the total costs for many medications, the report said.

But George Huntley, a representative of the Patient Pocket Protector Coalition, which works to hold prices down, told legislators that the savings are not usually passed on to us.

“That same consumer has paid a premium to their insurance carrier or their health plan for access to that plan’s benefits, but they’re not getting that plan benefit,” he said.

Huntley said the pharmacy benefit managers “were created for medical billing of pharmacy transactions. That was their purpose when originally created. They don’t make anything. They don’t touch anything. They report only to their shareholders. They don’t have a fiduciary responsibility for the health of the patient at all.”

Rep. Steve Sheldon, a Bowling Green Republican who owns Sheldon’s Express Pharmacy in Kentucky and Indiana, said PBMs used to simply form a connection between the insurance companies and the pharmacies, according to the LRC.

“If they want to charge 10 cents or a quarter, just let us know what you want to charge per transaction,” he said. “And let’s get rid of the rebates because we’re just never ever going to reel them in. But this is a good start. I think you’ll see some legislation next session that will have to do with all the money going back to the premiums except for a reasonable amount.”

The LRC reported that Sen. Ralph Alvarado, a Winchester Republican, said that reform might not come easily, but changes need to be made.

“I’ve already been told by some of our insurance partners they’re going to take us to the mat on this,” he said. “They’re going to fight tooth and nail. So I’m anticipating a very nasty fight on this. But I think the proof is already in the pudding here in Kentucky on Medicaid. And it’s already been shown that it’s going to work, and it’s going to benefit patients.”

Sen. Stephen Meredith, a Leitchfield Republican, said, “No one should make a fortune off the misfortune of others, and that’s exactly what’s happening. This is really falling on the most vulnerable. Here’s a chance to right this wrong.”

So, maybe — just maybe — we’ll see reform soon.

But the opponents have some tough lobbyists.

So, we’ll have to wait and see.