Pharmacy benefit manager agrees to records examination

December 20, 2018 GMT

HELENA, Mont. (AP) — A company that negotiates prescription drug prices on behalf of insurance plans agreed to a third-party examination of its records as Montana lawmakers work to rein in the increasing costs of prescription medications, the state auditor’s office announced.

In June, Montana proposed fining Prime Therapeutics and two other companies for operating without a license. Prime applied for a license, but it was denied because the pharmacy benefits manager would not provide information about its contracts and pricing data to state lawmakers investigating the reason for rising prescription drug costs.


Pharmacy benefits managers argue they use their buying power to negotiate lower prices from manufacturers, thus saving money for customers. Critics argue the pharmacy benefit managers don’t pass along manufacturer rebates, overcharge pharmacies and that in some cases their contracts don’t allow pharmacists to tell customers the cash price of some medications is less than their insurance co-payment.

Prime agreed to pay up to $375,000 for an examination of its contracts, including any kickbacks or rebates it receives to include specific drugs in its “formulary” of medications, under an agreement announced Wednesday by state Auditor and Insurance Commissioner Matt Rosendale. The third-party review also will look at Prime’s contracts with pharmacies.

Prime, which negotiates prescription prices for Blue Cross and Blue Shield of Montana, has a license in Montana as part of the agreement.

Similar licensing complaints against Express Scripts and Aetna are still open, Rosendale’s office said.

In a related move, the insurance commissioner’s office is supporting a bill to be introduced during the 2019 Legislature that would make insurance companies accountable for monitoring the prescription drug benefits offered through their insurance plans.

The bill would, in part, require prescription benefit managers to base their charges on the published average wholesale price of prescription drugs and use any manufacturer rebates to reduce premiums.