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Mississippi Patient Access Joint Letter

7/ 08


AUTHOR: 50SN Staff

DATE: Jul 08, 2019


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Mississippi Patient Access Joint Letter

Dear Mississippi Legislator:

Almost all consumers who have health insurance pay only a portion of the cost for prescription medications. Most health insurance providers contract with third-party companies called pharmacy benefit managers (PBMs) to administer and process prescription drug claims. PBMs and insurersset the out-of-pocket price a consumer must pay for medicine, a practice sometimes called “cost sharing”or “patient burden.”While biopharmaceutical manufacturers provide discounts to consumers and insurers via rebates negotiated by PBM middlemen, some PBMs and insurers keep the negotiated manufacturer rebates as profit—instead of passing those savings to the consumer or using those discounts and rebates to lower premiums and cut other costs. Mississippi is home to some of the nation’s strongest laws when it comes to ensuring all consumers have access to the right medication at the right time. However, the practice of some PBMs and insurers keeping rebate dollars instead of passing them on to consumers is influencing drug affordability. We urge you to consider the following policy goals to build a system that ensures consumers benefit from discounts and savings on necessary medications: Hold PBMs Accountable for Sharing Rebates & Discounts with Consumers: The rebate system was intended to generate cost-savings for consumers, but unfortunately has enabled PBMs and insurers to pocket rebates and discounts without any disclosure to consumers.Insurers and PBMs should reduce out-of-pocket cost burdens they would otherwise charge to an enrollee by an amount equal to or greater of a majority of the total rebates/discounts they receive from manufacturers.Shine Light on True Costs for Consumers:Consumers should not have to pay more than their insurer for a medication. To shine light on this practice, health insurers should also disclose to current and prospective enrollees the fact that they may be subject to an “Excess Cost Burden,” or out-of-pocket cost burdens that are greater than the amount that their insurer pays.Create Transparency & Disclosure:To ensure transparency and disclosure, PBMs and insurers should provide the Mississippi Board of Pharmacy with an annual report that discloses the total amount of rebates received, total rebates that did not pass through the insurer to the enrollee, and the total administrative fees received by the PBM. Health insurers should also be required to certify to the Board of Pharmacy that enrollees were provided at least a majority of || @PatientAccessMSWe respectfullyask that you and your colleagues in the Mississippi Legislaturejoin in implementing these critical recommendations this legislative session to ensure that all consumers benefit from a better healthcare system. Patients share the costs—it’s time for patients to share the savings.Sincerely, H.E.A.L.S. of the South U.S. Rural Health Network