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South Carolina hearing exposes wide disagreement over PBMs, rebates and vertical integration
Summary
A Medical, Military, Public and Municipal Affairs ad hoc committee heard competing testimony on pharmacy benefit managers’ role in drug pricing, vertical integration among insurers/PBMs/pharmacies, and whether transparency and new rules could lower costs and protect patients and community pharmacies.
Heath Sessions, chair of the ad hoc Medical subcommittee, opened a daylong session on pharmacy benefit managers (PBMs) that brought PBM trade representatives, health-plan officials, drugmakers, community pharmacists and patient advocates to the State House to describe a complex prescription-drug market struggling with rising list prices, opaque rebate flows and concerns about access and competition.
The hearing centered on whether PBMs, now tightly linked to insurers, specialty pharmacies and wholesalers, bring net savings for plan sponsors and patients or instead extract value from the supply chain. Jim Ritchie, executive director of the South Carolina Alliance of Health Plans, said the industry’s aim is to protect consumers and plan sponsors, arguing PBMs are “the countervailing negotiating arm for the consumer as relates to the manufacturer's pricing.”…
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