On Tuesday, March 2, 2021, a joint hearing was held for LB270 and LB375 at the Banking, Commerce and Insurance Committee chaired by Senator Williams. Both bills deal with pharmacy benefit managers, or PBMs. PBMs are companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. PBMs have a significant impact in determining the total drug costs for insurers, shaping access to medications by patients, and in determining how much pharmacies will be paid. Operating as the middleman in the health care delivery system, PBMs have created an extra layer in healthcare and can often lead to inefficiencies in providing care to patients.

It is for this reason that the Nebraska Medical Association was happy to support LB270 and LB375. At the hearing, the NMA was represented by our physician advocate, Dr. Marcus Snow. Dr. Snow is a rheumatologist and the current president of the Nebraska Rheumatology Society and current Chair of the American College of Rheumatology’s Committee on Rheumatic Care. Dr. Snow thoroughly presented how the current, unregulated PBM market can hurt patient care, increase healthcare costs, and take decision-making power away from physicians. Dr. Snow discussed how PBMs circumvent local pharmacies for preferred mail-ordered medications. By requiring patients to receive their medication through the mail and restricting what patients are able to purchase from local pharmacies, PBMs affects the local economy of Nebraska.

Dr. Snow also refuted the claim that PBMs lower drug costs by negotiating discounts for high-priced medication. However, with the lack of transparency for either the physician or the patient in their rebate system and the rising drug costs, it is not clear where the benefit of lower costs goes; it is certainly not going towards the patient.

Finally, Dr. Snow addressed the practice of “accumulator” plans as a way to discourage the use of costly medications, even if those are the ones uniquely suited to the patient. Drug manufacturers have helped provide financial support to patients to assist in payments of medication co-pays. However, with these “accumulator” plans, any payment not personally supplied by the patient does not count toward the patient’s deductible, making medication purchases throughout the year more expensive for patients and their families.

The NMA fully supports the efforts of LB270 and LB375. We need less intervention between physicians and their patients. Supporting this legislation will help reduce unnecessary follow-up visits with patients who have been forced to switch medication, would reduce the additional and costly administrative work in physicians’ offices, would support local pharmacies, and would reduce the unnecessary delays to get the appropriate medication to patients.