Madison, WI – Today, Senate President Mary Felzkowski (R-Tomahawk) and Representative Todd Novak (R-Dodgeville) introduced Cole’s Act: legislation to reform pharmacy benefit managers (PBMs). PBMs engage in predatory practices to line their own pockets at the expense of independent pharmacies and patients.
In theory, PBMs are middlemen hired by insurance companies to manage and negotiate better prices for patients’ prescription drug benefit programs. In practice, 89% of drug claims are controlled by the three largest PBMs, which are part of vertically integrated Fortune 500 healthcare companies that also own large pharmacy chains. These huge corporations discriminate against local pharmacies, pocket tax dollars meant to expand healthcare for the neediest among us, and make unexpected changes to patients’ drug coverage. These actions make PBMs richer to the detriment of consumers.
The Schmidtknecht family from Poynette, Wisconsin, lost their son as a result of PBM actions. 22-year-old Cole went to the pharmacy for a routine pickup of his inhaler and was shocked that his prescription had increased from $66 to $539.19. A college student, Cole was forced to choose between his prescription and paying his rent. Cole died days later from an asthma attack after delaying the inhaler purchase. Predatory PBM practices, including failure to notify Cole of this price change, are the primary factors in Cole’s death.
Senator Felzkowski and Representative Novak are introducing Cole’s Act to protect consumers and ensure that doctors, not PBMs, dictate what drugs patients take. Cole’s Act will lower drug costs, increase transparency, and increase pharmacy access and safety. The legislators issued the following joint statement:
Cole’s death was an unnecessary tragedy. The hidden truth of healthcare right now is that PBMs control what drugs are available to patients, not doctors. We cannot allow these practices to continue.
We are pleased to see the Trump Administration also begin to address the predatory practices of PBMs, but Wisconsin cannot wait for the federal government. We must pass Cole’s Act to protect local pharmacy access, prevent surprise drug cost increases, and prevent unnecessary deaths like Cole’s.
