The Senate Pharmacy Benefit Manager Monitoring Advisory Council convened on September 22, 2025, to discuss critical issues surrounding drug pricing and the role of pharmacy benefit managers (PBMs) in Louisiana. The meeting featured a presentation by Alexander Oshmyansky, CEO of Cost Plus Drug Company, who shared insights into the pharmaceutical industry's pricing practices and the impact on patient access to medications.

Oshmyansky, a trained radiologist, began by recounting his motivation for entering the pharmaceutical sector, which stemmed from witnessing patients suffer due to unaffordable medication costs. He highlighted a notorious incident involving Martin Shkreli, who infamously raised the price of a life-saving drug, prompting Oshmyansky and colleagues to establish a nonprofit aimed at providing affordable medications. After initial setbacks, they transitioned to a for-profit model, ultimately launching Cost Plus Drug Company with the backing of investor Mark Cuban.

During his presentation, Oshmyansky explained the company's unique pricing model, which emphasizes transparency. Cost Plus Drug Company reveals the actual costs of medications, applying a flat 15% markup plus a $5 fee for pharmacy services. This approach has allowed the company to offer significant savings on various medications, often reducing prices by 50% or more compared to traditional pricing structures.

Oshmyansky criticized the conventional pharmaceutical pricing model, which he described as a "scam" that obscures true costs through high list prices and hidden fees. He pointed out that PBMs often negotiate prices that do not reflect the actual costs of drugs, leading to inflated prices for consumers. He commended Louisiana's legislative efforts, particularly Bill 474, which aims to address these pricing discrepancies and promote transparency in drug pricing.

The presentation also touched on the evolving tactics of PBMs, including the establishment of their own pharmacies and the use of overseas subsidiaries to obscure pricing practices. Oshmyansky warned that while progress has been made, ongoing reforms are necessary to combat these emerging challenges in the pharmaceutical landscape.

The meeting concluded with Oshmyansky expressing optimism about the potential for private sector innovation to drive change in drug pricing, alongside the need for continued advocacy for public sector reforms. The council's discussions underscored the importance of transparency and accountability in the pharmaceutical industry, as stakeholders seek to ensure that patients have access to affordable medications.