Pharmacy benefit manager settles case with state

Prime Therapeutics, the pharmacy benefit manager of Blue Cross and Blue Shield of Montana, has settled a case with the Montana Commissioner of Securities and Insurance Office and agreed to pay up to $375,000 for an independent examination of its data.

The settlement with Prime follows Commissioner Matt Rosendale’s administrative actions against pharmacy benefit managers in June for alleged violations of Montana insurance law. The case against Prime is the first to reach a resolution. Rosendale’s office has additional actions pending against Express Scripts and Aetna.

Prime has agreed to pay the costs of an independent, third-party examination of its data by Remedy Analytics as part of the settlement.

Rosendale announced the settlement with the pharmaceutical industry middleman as the latest development in his office’s prescription Drug Savings Initiative to reduce the high costs of prescription drugs and reform the way the pharmaceutical industry operates in Montana. As part of the initiative, Sen. Al Olszewski, R-Kalispell, is sponsoring legislation drafted by Rosendale’s office to reform the way the prescription drug industry operates in Montana.

Senate Bill 71 would make insurance companies accountable for the prescription drug benefits offered through their health insurance plans. It would eliminate unethical practices, including kickbacks, price gouging, and clawbacks by pharmaceutical industry middlemen that result in Montanans overpaying for medication. The bill will be introduced in the 2019 Montana legislative session.

Rosendale began investigating the high cost of prescription drugs nearly two years ago. His office has since launched a full court press against pharmaceutical industry practices that harm consumers and drive up costs.

In addition to legislation, the Drug Savings Initiative includes legal actions against pharmacy benefit managers, leading the Legislature’s interim study on drug costs, coordination with other states and members of Congress, and hiring a Montana expert who saved the state’s health plan $7.4 million in prescription drug costs by enacting similar reforms as those contained in Senate Bill 71, according to a press release from Rosendale’s office.

More information about the initiative can be found at https://csimt.gov/prescription-drug-costs/.