
How Pharmacy Benefit Managers Impact Illinois Patients
Clip: 3/17/2025 | 4m 29sVideo has Closed Captions
Gov. J.B. Pritzker has a plan he says will lower prescription costs.
Gov. J.B. Pritzker is calling it one of the greatest ironies of the modern age: There are breakthroughs in live-saving medicines, but they're so expensive that they're out of reach.
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How Pharmacy Benefit Managers Impact Illinois Patients
Clip: 3/17/2025 | 4m 29sVideo has Closed Captions
Gov. J.B. Pritzker is calling it one of the greatest ironies of the modern age: There are breakthroughs in live-saving medicines, but they're so expensive that they're out of reach.
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Learn Moreabout PBS online sponsorshipPritzker is calling it one of the great ironies of the modern age breakthroughs in life, changing even life-saving medicines.
They're so expensive.
They're out of reach and authentic.
He joins us now with the plan.
The governor says will lower prescription costs.
Amanda Rennes, we're going to get to the governor's pitch for saving consumers on drug prices in just a bit.
But first, I want to talk about an explanation is something that at first blush seems really basic and that's getting a prescription filled.
The doctor writes the script to you, get it filled at a pharmacy, but the pharmacy isn't in full control.
There's a go-between for called pharmacy benefit managers or >> pb >> So they're the Webster's dictionary definition of a middleman.
So the PBM sits between the durance company and the pharmacy and they determine what reimbursement is how it gets reimbursed personally reimbursed and most importantly and most frustratingly is what patients pay and what they can and cannot get when they go to the pharmacy.
>> You heard that right?
What patients can and cannot get from the pharmacy.
That's Chad Kodiak, who owns Cotto Care in Joliet.
He says PBM practices have nearly driven him out of business.
He shares one example of working with a parent to secure an attention deficit disorder, medicine for their child.
He order the medicine from a wholesaler, but the PBM didn't reimburse him.
The whole amount Kodiak says it's one of many instances in which he had to tell the patient our pharmacy can't afford to fill your prescription anymore.
>> The PBM is cut the reimbursement for those kinds of medications and others so severely and so deeply that every time we are filling the prescription, we're losing $50.
>> Plus, he says that the PBM also refused to pay the pharmacy dispensing fee.
That's a fee that they otherwise generally get that supposed to cover things like.
>> Labor uphill battle, the label and such.
I why not?
Well, Cody, a call back the billion-dollar question.
It is one that he and really nobody besides PBMs can answer.
>> Because not only is there no regulation for these PM's, they are completely protected by all kinds of secrecy.
So we have no idea.
There's no transparency.
There's no way to know.
>> critics have their suspicions, though, the major PBM zone pharmacies themselves and the thought is that these PBMs are paying their own pharmacies, higher reimbursements and independent ones.
Now it is one of the ways the Illinois lawmakers are considering stepping in by banning PBMs from steering consumers to pharmacies where they have a financial interest.
Then there's also a suggestion that Illinois can take control where it has it with prescriptions covered through state, run Medicaid also by dealing with the transparency issue by forcing PBMs to open their books to the state insurance Department and what a PBM about all this.
Well, so they rejected that they should be blamed for increased drug class.
Instead, they say look to big pharma for that.
Now the however it did not respond right away to my specific questions.
But when the governor made PBMs the focus of his budget address last month, the association representing PBMs issued a statement saying to be clear, the core mission of PBMs is to lower prescription drug costs and increase access to medications.
The statement says.
The Senate sponsor of the measure to further regulate them, so says instead he seeing patients who can't afford medicine, they need to be healthy.
>> Pharmacy benefit managers probably started out with good intentions and that is to be able to lower the price negotiating discounts with the manufacturers and then passing those on to know the plan sponsor or to the consumers.
That just hasn't happened.
>> The legislation still in negotiations, Illinois, somewhat limited by what it can do.
Pharmacies say really they want federal action, but the pharmacist that I spoke with lot.
Kodiak says that if something doesn't happen, he is serious about joining the 80 or so other independent pharmacies that last year closed in Illinois.
He said he's taking out a line of credit.
He's exhausted much of his personal savings and that's where things are at ensure.
A very tough spot for for those pharmacist.
Amanda,
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