Do PBMs disrupt patient-physician relationships? 6 thoughts

Minnesota State Rep. Rod Hamilton, R- Mountain Lake, proposed legislation to limit pharmacy benefit manufacturer's ability to change a patient's drug treatments, according to the Star Tribune.

Here are six things to know.

1. Rep. Hamilton was diagnosed with multiple sclerosis more than 20 years ago and struggles with severe pain and exhaustion on a daily basis. He takes a drug called armofadinil to limit his fatigue, according to the report.

2. Last year, a PBM told Rep. Hamilton he could only take one armofadinil pill per day, instead of two, as recommended by his physician at Minneapolis-based Mayo Clinic. So while he pays $37.07 per month for the drug, his pharmacist is not allowed to distribute more pills than instructed by the PBM, according to the report.

3. "What's the outcome? I'm in a wheelchair," Rep. Hamilton told Star Tribune. A year ago, when he was taking the drug twice a day, he could climb the four flights of stairs to his office in the Capitol building. Now he travels through the building in a wheelchair, according to the report.

4. Rep. Hamilton's legislation would limit PBMs' ability to change medication guidelines to protect the relationships between patients and their physicians. Numerous physicians and healthcare groups are backing the bill, saying they spend a large amount of time and money communicating with PBMs to authorize medications, according to Star Tribune.

5. While the bill passed with bipartisan support out of a Senate committee last week, Rep. Hamilton has not been able to schedule a hearing in the House Commerce Committee, where the bill currently sits.

6. Committee Chairman Rep. Joe Hoppe, R-Chaska, told Star Tribune the legislation would increase the cost of health insurance — during a time when rates are already rising — so he cannot justify holding a hearing for it.

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