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Drug-benefit manager agrees to provide pricing data to Rosendale’s office

Posted at 4:40 PM, Dec 19, 2018
and last updated 2018-12-20 12:29:24-05

HELENA – A drug-benefits company has agreed to provide state regulators with its Montana pricing and contract data, which could help efforts to force lower prescription drug prices, state Auditor Matt Rosendale said Wednesday.

“This is a step in the right direction for tackling the high cost of Montanans’ medications,” Rosendale said in a statement. “The drug industry hides behind its complexity and claims it has consumers’ best interests at heart.

“The data will prove whether that claim is true or false.”

Prime Therapeutics, a prescription-drug benefit manager for Blue Cross and Blue Shield of Montana, the state’s largest health insurer, agreed Tuesday to pay up to $375,000 for an independent examination of its data.

Rosendale, whose office regulates health insurance, said he’ll use the information to formulate policy and proposals designed to reduce what consumers pay for prescription drugs.

“What we have is big pharma … using fancy terms like `spread pricing’ and `rebates,’ that sound like they’re benefiting the consumer when it reality it boils down to price-gouging and kickbacks for the industry,” he told MTN News in an interview earlier this month.

The data provided by Prime Therapeutics will include its contracts with Blue Cross, pharmaceutical manufacturers and certain pharmacies, rebates and amounts billed for pharmacy claims, going back several years.

Prime Therapeutics is co-owned by two dozen Blue Cross companies nationwide. Rosendale has called it a “multi-billion-dollar company.”

Earlier this year, Rosendale’s office took action against the company and two other prescription-drug benefit managers.

He said they’re operating in the state without a license and can’t get one unless they answered questions about their business practices.

In the agreement signed Tuesday with Prime Therapeutics, Rosendale’s office agreed to approve the company’s license in Montana.

The company agreed to provide the requested information within eight weeks to Remedy Analytics, a Wisconsin health-care technology firm that analyzes claims data.

Remedy then will provide a report for Rosendale’s office.

Rosendale said the actions against the drug-benefit managers are part of his “drug savings initiative,” which will include legislation at the 2019 Legislature.

Sen. Al Olszewski *(R-Kalispell) has already pre-introduced a bill drafted by Rosendale’s office to crack down on a number of pricing practices that Rosendale says force consumers to pay higher-than-necessary drug prices.

Rosendale said earlier this year that consumers and pharmacists have complained to him about how drug-benefit managers prevent consumers from getting information on drug prices.

He said one complaint said a PBM contract prohibited pharmacists from telling consumers that they could pay less by paying cash for the drug, rather than using their health coverage.

A spokesman for Blue Cross in Montana said Wednesday the company is not part of the regulatory action against Prime Therapeutics and that its customers haven’t been impacted.

 – Mike Dennison reporting for MTN News