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Pharmacy 'clawbacks' targeted in latest state law aimed at PBMs

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Connecticut legislators have taken aim at a contentious PBM practice that has spawned multiple lawsuits around the country. So-called clawbacks occur when the copayment for a drug exceeds its actual cost.

Connecticut legislators have taken aim at a contentious PBM practice that has spawned multiple lawsuits around the country. So-called clawbacks occur when the copayment for a drug exceeds its actual cost. Because contracts between the PBM and pharmacy prevent the store from disclosing the lower-priced cash option, customers fork out the copay and the PBM keeps the overpaid amount for itself. To combat the questionable practice, starting next year Connecticut will authorize pharmacists to steer customers to the most affordable way to pay for prescription medications they fill. "Connecticut has now joined a number of states that have outlawed these secret clawback schemes since they were first exposed last year," said Connecticut attorney Craig Raabe. "Consumers will benefit from these overcharge bans because they should not pay more than an insurance company actually pays for a prescription medicine." The Pharmaceutical Care Management Association, a lobby organization representing PBMS, said its members "support the patient paying the lowest price available at the pharmacy counter for the prescribed drug."

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https://www.bloomberg.com/news/articles/2017-07-11/pharmacy-clawbacks-targeted-in-latest-state-law-aimed-at-pbms

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