OCI Releases Task Force Report on Reducing Prescription Drug Prices

On Oct. 21, the Office of the Commissioner of Insurance (OCI), with Deputy Commissioner and Task Force Chair Nathan Houdek’s signature, released the Governor’s Task Force on Reducing Prescription Drug Prices final 2020 report. The report is the product of the task force’s work to identify strategies to improve prescription drug affordability and accessibility for Wisconsin citizens.

Included in the 100-plus page report are three tiers of policy recommendations for consideration, a deeper explanation of each of the issues, and letters from interested parties sharing their feedback on the policy concepts being discussed.  The “PBM bill,” 2019 AB 114/SB 100, as amended by ASA 1, was listed as the first recommendation and separate from the tiers. 

The reports first tier is “several recommendations where a majority of the Task Force, after weighing the pros and cons of each, determined the recommended action to be a positive step toward reducing prescription drug prices. In some cases, the recommendation has a more direct impact on pricing and in others, a greater level of transparency is offered that will help inform future discussions.” Tier One recommendations include:

  • Statutorily limit the copay an insurer can charge for a month’s supply of insulin.
  • Require additional transparency and reporting for prescription drug supply chain entities to better understand the drivers of high-cost prescription drugs and inform future policymaking.
  • Increase the number of Department of Justice consumer protection and anti-trust attorneys focused on improper pharmaceutical industry practices.
  • Increase the annual appropriation for free and charitable clinics, dedicating a portion of the funding to pharmacy, to expand access.
  • Develop a statewide, medication repository with a centralized prescription drug inventory in Wisconsin or collaborate with an existing medication repository program in another state.
  • Allow one-third of continuing education requirements for pharmacists to be dedicated towards volunteerism.
  • Support efforts by the Wisconsin Association of Free and Charitable Clinics and other stakeholders to remove barriers that unnecessarily prohibit the Wisconsin Drug Repository Program from accepting prescription drug donations from other states.
  • Ensure that Federally Qualified Health Centers, Critical Access Hospitals, and Ryan White HIV/ AIDS programs participating in the 340B drug discount program are able to reinvest savings from drug purchases into patient care and support activities.
  • Create a public sector prescription drug purchasing entity, initially for government purchasers as a means to leverage purchasing power and other cost-saving opportunities that may be available.
  • Require Pharmacy Services Administration Organizations (PSAO) executing agreements with pharmacists in Wisconsin to be registered or hold a state license.
  • Explore and support efforts to improve physician access to real-time patient pharmacy benefit information in electronic medical records (EMRs) to allow physicians to consider out-of-pocket costs when prescribing medications. Also, explore access to the total drug cost so that decisions can be made that may save costs at a system level.
  • Advocate for federal regulatory changes to address practices that delay the market entry of affordable generic equivalents and other market practices identified as drivers of prescription drug unaffordability.

Tier two recommendations are “policy proposals that have been raised and discussed, to some extent, throughout the work of the Task Force since the first meeting in November 2019. These proposals are not necessarily Task Force recommendations; however, these proposals may merit further discussion and consideration outside of the work of the Task Force. Also, of note, at least one Task Force member expressed support for each of these proposals, while others have expressed concern or opposition. Including these proposals is important for meeting the requirement to summarize the work of the Task Force, as directed by Executive Order #39.”  Tier Two recommendations include:

  • Require insurers to apply manufacturer prescription discounts utilized by consumers to deductibles and annual maximum out-of-pocket costs, if no generic exists or where a generic exists but the beneficiary obtained access to the prescribed drug after undergoing prior authorization, step therapy, or the insurer’s exceptions and appeals process.
  • Create a prescription drug affordability/accountability review board to establish prescription drug spending targets for public sector entities and explore establishing price limits.
  • Encourage providers and insurers to adopt, as a best business practice, the administration of specialty drugs at the lowest-cost setting available, taking into account specific patient needs, the drug, and clinical appropriateness to ensure patient safety.
  • Allow wholesale importation of prescription medication from Canada. Develop best practice guidelines for PBM business practices.
  • Enhance public awareness of pharmaceutical manufacturer patient assistance programs.

Tier Three includes concepts that were raised by task force members, but limited time did not allow for lengthy conversation on the subject matter.  OCI wanted to acknowledge these concepts but clarify they needed more analysis. These Tier Three concepts are:

  • Licensure and regulation of pharmaceutical sales representatives.
  • Additional regulatory oversight (licensure or regulation) of PBM brokers and consultants.
  • Require PBMs to act as a fiduciary on behalf of their plan sponsors.
  • At free and charitable clinics, consider expanding pharmacist responsibilities, implementing telepharmacy services, and making it easier to allow remote dispensing sites, in particular, for onsite inspections.
  • Allow the state Department of Justice (DOJ) to have direct Civil Investigative Demand (CID) authority for anti-trust cases without seeking court authority each time.
  • Additional restrictions on improper prescription drug marketing and advertising practices.
  • Create an insulin safety net program.
  • Create a value-based pilot project for diabetes medications.