Fresh off a legislative session that saw major changes to how health insurers operate in Illinois, policymakers are setting their sights on pharmacy benefit managers.
“A big focus of the General Assembly is going to be on PBMs,” Department of Insurance Acting Director Ann Gillespie said Wednesday during a Health News Illinois virtual event. “Whether that’s veto session or whether that’s next spring remains to be determined. But I think that will be one of the big focuses.”
Gillespie called for more transparency on how PBMs operate, echoing a concern of lawmakers at a legislative hearing last week.
“One of the things I was told as I moved into this job is that a regulator calls balls and strikes,” said Gillespie, who resigned her Senate seat this spring to head the insurance department. “But you can’t do that when you’re wearing a blindfold.”
At last week’s hearing, Connor Rose, senior director of state affairs at the Pharmaceutical Care Management Association, said PBMs aren’t opposed to more transparency. But, if some information is made public regarding negotiations with drug manufacturers or pharmacies, it could “adversely affect our ability to negotiate lower prices.”
“As far as it relates to transparency to plan sponsors, we want them to be educated and we want them to make decisions based on good information so that they can provide the best plan for their enrollees at the most affordable cost, with the highest quality,” he said.
Gillespie hinted that policymakers may also look at how PBMs contract with small, independent pharmacies. She said this is a big issue in rural parts of the state. It also impacts urban areas that lack national pharmacy chains.
“They don’t have the bargaining power that the chains do to negotiate with the PBMs. And so getting some relief for those individual, independent pharmacies is critical, ” Gillespie said. “It’s not a competitive issue. It’s an access issue.”