The core mission of pharmacy benefit managers (PBMs) is to reduce prescription drug costs for health plan sponsors so that consumers have affordable access to needed prescription drugs. PBMs offer a variety of services to their health-plan-sponsor clients and patients that improve prescription adherence, reduce medication errors, and manage drug costs.
The proposed Mississippi legislation will seriously undermine the ability of PBMs to control drug costs, and as a result drug spending in Mississippi will soar. Although many of the provisions are vague and subject to various interpretations, enacting just the three bill provisions discussed below could cost the state of Mississippi up to $100 million in excess drug spending in the first year alone, and $1.2 billion over the next 10 years.
1. Section 4. 73-21-156 Mandated Changes to PBM MAC Lists: requiring PBMs to change their Maximum Allowable Cost (MAC) lists would remove incentives for pharmacies to purchase the most cost-effective generic drugs. Generic drugs comprise 90% of all prescription drug fills, inefficient purchasing of these would cause drug costs to soar. This type of “guaranteed profit” legislation undermines competitive market dynamics, is a giveaway to pharmacy special interests, and would harm Mississippi employers, unions, and patients.¹