Lawmakers approve measure to stop pharmacy cost clawbacks

Lawmakers approve measure to stop pharmacy cost clawbacks

NEW ORLEANS (WVUE) - Louisiana's legislature has passed a bill that could end the practice of prescription drug "clawbacks" in the state.

Senate Bill 131 by Ronnie Johns of Lake Charles "provides that an individual shall not be required to make a payment for pharmacy services in an amount greater than the pharmacist or pharmacy providing the services may retain from all payment sources."

Right now, some pharmacy customers are paying more in co-pays than their drugs actually cost, due to contractual arrangements between pharmacies and pharmacy benefit managers. Those PBM's administer prescription drug coverage for health insurance carriers, such as United Healthcare and Aetna.

FOX 8 investigated the questionable practice in Lee Zurik's "Medical Waste" series. We found one example in which a patient prescribed Sprintec to treat severe acne was charged just $11.65 for the drug itself, taxes and pharmacist's fee. But the patient had to pay the $50 copay in full - the remaining $38.35 was sent back to the insurance company's PBM.

Under existing contracts, pharmacists are barred from directly suggesting a lower-cost option – paying without insurance coverage, for instance – unless a customer asked about such options.

SB 131 expressly voids any contract that precludes such a discussion.

The bill passed the Senate on a 36-0 vote in May, and House members voted 95-0 in favor of it Thursday. It's now headed to Governor John Bel Edwards' desk. If he signs it, the new law takes effect at the start of 2017.

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