WA Legislature Considers Tougher Regulation For Health Care Benefits Managers

Jan 27, 2020

A bill co-sponsored by Sen. Shelly Short (R-Colville) would put stronger regulations on health care benefits managers.
Credit TVW

A Washington state Senate committee is considering new regulations on companies that help people access health care. The bill, in particular, targets so-called “pharmacy benefit managers.”

“Pharmacy benefit managers” are third-party companies that work with pharmacies and with firms that offer health plans. They negotiate better rates for patients and make sure pharmacies are paid, among other things.

They’re required to register with the state Insurance Commissioner’s office to do business in Washington.

Some legislators, including Sen. Shelly Short (R-Colville), believe some benefits managers are gouging customers, including pharmacies. They’re proposing a stronger form of oversight.

Ryan Oftebro, who owns a pharmacy in Seattle, testified Monday at a hearing of the Senate Health and Long Term Care Committee.

“Our pharmacy’s been serving patients with HIV and AIDS since the early days of the epidemic," Oftebro said. "We’re seeing a disturbing trend that PBMs are categorizing medications used to treat or prevent HIV as specialty drugs. When this happens, patients are no longer able to access their medications through their preferred community pharmacy and must transfer to a specialty pharmacy toward the PBM’s own mail order practice.”

Christine Brewer from the Association of Washington Health Care Plans says health insurers are concerned that the new legislation would define too many people as benefits managers. She says they want to negotiate to make the bill more palatable to them.