Resolution 18-211

Submitted by: Richmond Academy of Medicine

WHEREAS,       current prices for pharmaceuticals are rising more quickly than other health care costs, and

WHEREAS,       rising insurance premiums, pharmaceutical copays, and out-of-pocket costs often result in the patient/consumer not being able to adhere to proposed treatment plans, and

WHEREAS,       Pharmacy Benefit Managers (PBMs) currently determine the content of most formularies for health care plans and companies providing health care within the Commonwealth of Virginia, and

WHEREAS,       PBMs also provide the majority of all pharmacy claim processing services, including but not be limited to negotiating drug prices, processing and adjudicating prescription requests, contracting with pharmacists or pharmacies, maintain pharmacy benefits networks, receiving payments for pharmacist services, making payments to pharmacists, negotiating, disbursing or distributing rebates, and handling all appeals, and

WHEREAS,       PBM use of restricted formularies, prior authorization, utilization review and step therapy protocols are resulting in the disruption of the physician-patient relationship and interference in the agreed upon individualized treatment care plans, and

WHEREAS,       PBM contracts with local pharmacies often result in limiting the pharmacist’s scope of care or ability to provide pharmacist services, thereby frequently resulting in increased costs to patients/consumers, and

WHEREAS,       all PBM activities are not currently licensed or regulated by the Virginia Insurance Commissioner, therefore be it

RESOLVED,     that the Medical Society of Virginia, in concert and collaboration with local and specialty physician organizations, pharmacist organizations, patient organizations and any other interested and affected parties work to ensure that the Virginia Insurance Commissioner has authority to appropriately oversee the actions of PBMs providing services to Virginians similar to the recently enacted Arkansas legislation (HB 1010) so PBM's are brought under oversight and held accountable for their actions in the pricing, management and dispensing of medications to Virginians.

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