FILE - Walmart pharmacy, prescription drugs

The Georgia House Majority Caucus plans to propose legislation aimed at providing more oversight of corporate health care companies with the hope of saving taxpayer money.

Lawmakers said they will introduce a bill that will remove “loopholes” from existing laws that fail to protect Georgians from exploitative practices by pharmacy benefits management companies.

“Lowering costs, empowering patients and improving outcomes are the holy grails of health care legislation,” said House Speaker David Ralston, R–Blue Ridge. “We are going to significantly advance all three of those goals with this legislation in 2020.”

Pharmacy benefit managers are subcontractors that often dictate how much a pharmacy can charge a customer for certain prescription medications. 

Some managed care companies have been accused of taking advantage of self-referrals and price inflation.

Managed care company Centene has an ownership stake in two pharmacy benefit managers used by Georgia. According to a 2018 appropriations report, Georgia spent $120 million on pharmacy benefits, but only $90 million was used for drug reimbursement. The remainder was kept by the pharmacy benefit managers.

The plan to add more oversight is a result of a series of meetings by the House Special Committee on Access to Quality Health Care. The committee's goal is to find solutions for the state’s health care issues.

The proposed legislation also would separate prescription drug benefits from Medicaid managed care. That means the state would work directly with the pharmacy benefits management companies. It is a move that lawmakers say will save the state millions of dollars. 

In March, the West Virginia Bureau for Medical Services reported that it saved more than $54 million on the state Medicaid program for the first year that it “carved out” prescription drug benefits.

Members of the caucus said it is part of their plan to reverse corporate control of health care in the state.

 “Wall Street is bleeding us of money and choices, and we are going to take both of those back,” Rep. David Knight, R-Griffin, said. “The money and decision-making power have been shipped by massive health care companies to Wall Street, where it has enriched investors while hurting those who need care across Georgia.”

Gov. Brian Kemp signed House Bill 233 into law in May, which stops misuse by third-party administrators of prescription drug programs for profit by restricting self-referrals. The bill also limits data mining and adds opportunities for audits and disclosure of affiliates.

“Today, we heard from patients and providers about opaque practices of [pharmacy benefits management companies] and managed care organizations that increased costs to patients and taxpayers and, more importantly, compromise the health of Georgians,” Majority Caucus Chairman Matt Hatchett, R-Dublin, said. “We are committed to bringing a stop to these practices.”


Staff Reporter

Nyamekye Daniel has been a journalist for three years. She was the managing editor for the South Florida Media Network and a staff writer for The Miami Times. Daniel's work has also appeared in the Sun-Sentinel, Miami Herald and The New York Times.