Relates to requiring certain health insurance issuers to certify that at least a majority of prescription drug rebates are provided to patients at the point of…

• Democratic23
• Republican1

◆ The sponsor's argument

Why Robert Jackson says this is needed

The difference between list prices of prescription drugs and the net prices paid by pharmacy benefit managers and health insurers has been growing exponentially in recent years. While many entities benefit from these large negotiated discounts - estimated at $166 billion in 2018 one group gets the short end of the stick: patients. As more and more health insurance benefit designs rely on coinsurance and deductibles, patients end up paying cost sharing on the list price of the drug even as their health plan is reaping significant discounts. Unlike negotiated discounts on other services like hospital care, these savings are not shared with patients in the deductible phase of a plan and patients often end up paying more than their health plan for a drug. Plans argue that the discounts are used to lower premiums for everyone, but patients with complex and chronic conditions end up carrying the biggest burden - exactly the opposite of how insurance should work. This bill strikes a careful balance, allowing rebates and discounts to be socialized and keep premiums down to a point, but also making sure some of those significant discounts are passed along to the place they're most important to patients - at the pharmacy counter. West Virginia is currently the only state requiring drug rebates to be passed along to the patient at the point of sale. The legislation is considered the model for other states with rebates at 100$ being passed along to patients. Many health plans have already implemented this option and have marketed this approach as good for patients and "worth it."

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.