KRMG In-Depth: Why Congress wanted to learn how Oklahoma regulates pharmacy benefit managers

TULSA — Recently, Oklahoma Insurance Commissioner Glen Mulready went to the nation’s capitol to discuss how the state handles the regulation of pharmacy benefit managers.

In the House Ways and Means Committee’s Health Subcommittee, he testified during a hearing entitled “Why Health Care is Unaffordable: Anticompetitive and Consolidated Markets.”

[Hear our KRMG In-Depth report on PBMs featuring Commissioner Mulready HERE]

He tells KRMG his testimony was primarily about the law passed in Oklahoma in 2019 to prevent certain practices by those prescription benefit managers (PBMs).

“We are leading on that,” he told KRMG, referring to Oklahoma as the “tip of the spear” on PBM compliance and enforcement.

“We have issued fines of $3.5 million since we began enforcement September 1st of 2020. We’ve reimbursed back to pharmacies over $700,000.”

PBMs, he explains, work as a sort of “middle man” between insurers - be they insurance companies, or large employers who self-insure - and the pharmacies to try and maximize efficiency and minimize costs.

It is a hugely profitable industry.

“We are talking - and in my testimony last week, I said, you know - two of the top three are Fortune 10 companies. These are hundreds of billions of dollars companies,” Mulready said.

But he’s not ready to just throw PBMs under the bus, noting that companies hire them for a reason.

“They are not required to contract with a PBM. They contract with them because they believe they provide a service,” he said. “Do they need to be reeled in? Absolutely.”

But he thinks the real problem may lie with drug manufacturers, and the Pharmaceutical Care Management Association (PCMA)- a trade group for PBMs - agrees.

According to PCMA, the price for a year’s supply of a new drug ran about $2,000 in 2008.

That figure in 2021, it claims, was about $180,000.





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