Georgia Lawmakers Seek to Regulate PBMs to Ensure Patient Access to Life Saving Medications

Jan 22, 2020

A Joint Special Committee on Access to Quality Health Care and Insurance convened in Atlanta on January 7th to hear testimony from pharmacists, patients and physicians across the state of Georgia on how pharmacy benefit managers (PBMs) present challenging barriers for patients to gain access to needed medications. 

This hearing was convened because it was believed to be necessary as Representative Eddie Lumsden (R) Chairman of the House Insurance Committee commented at the onset of the hearing. In the 2019 legislative session, Representative David Knight (R) passed the Anti-Steering and Transparency Act to prevent PBMs from guiding patients away from community and independent pharmacies. Despite passage of this legislation, many patients, pharmacists and physicians have expressed continuing challenges with PBMs. 

During the hearing, heartbreaking testimony was delivered by numerous stakeholders including cancer survivor, Katie Groover who recounted her struggles in speaking to dozens of individuals at the mail order drug company where she purchased the specialized medications she requires. "I don’t know these people," she said.  "They don’t know me, and I don’t think I’ve ever talked to the same person twice.” Groover shared that she ultimately ran out of money to pay for her medications, and she is now sourcing her medications straight from the manufacturer with the assistance of her doctor, but she says there is no way to tell how long the manufacturer and her doctor will be able to provide these medications to her. 

Several pharmacists, including Jennifer Shannon, owner of Lily’s Pharmacy, provided the independent pharmacy perspective at the hearing. Shannon stated that while Groover’s story is horrifying it is not unique and that patients who must seek prescription assistance through mail order call centers are getting their health advice from customer service representatives who do not have the personal relationship and attention a community provider has already established with the patients for which they care. Shannon stated, “When a brand-name drug is mandated when there is a therapeutic generic drug available, that is not a clinical decision. That is a profit-driven decision.”

Since the hearing, the House Majority Caucus has announced that Rep. Knight plans to introduce additional legislation in the 2020 session with the intent to ensure patient access and affordability to medication by closing existing loopholes in the law and bringing oversight to PBMs and Medicaid managed organizations in Georgia. 

Access this Link for video from the hearing. 

 

Katie Groover, Representative David Knight (R) and Jennifer Shannon, Owner of Lily’s Pharmacy

Katie Groover, Representative David Knight (R) and Jennifer Shannon, Owner of Lily’s Pharmacy

Cancer survivor Katie Groover providing testimony at the hearing.

Cancer survivor Katie Groover providing testimony at the hearing.