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Legislature, Health officials evaluate bill to regulate Puerto Rico pharmacy benefit managers

By on February 2, 2018

SAN JUAN — The Puerto Rico House Health Committee, chaired by Rep. Juan Oscar Morales, continues to analyze a bill that seeks to establish an oversight framework for the island’s pharmacy service managers and administrators.

Senate Bill 218, authored by Sen. José Dalmau and co-authored by Sens. Migdalia Padilla and Ángel Martínez, would create the Pharmacy Services & Benefits Administrators Regulation Act and establish the Regulatory Commissioner’s Office, ascribed to the Health Department.

It also seeks to establish powers and enforcement faculties for pharmacy benefit managers (PBMs) and pharmacy benefits administrators (PBAs). In turn, it proposes to give jurisdiction to the Patient Advocate’s Office (PAO) to address complaints related to PBMs, PBAs and any similar entity that contracts services with pharmacies in Puerto Rico.

The committee chairman stressed at the public hearing that “the primary purpose of this bill is to approve something that regulates PBMs and, at the end of the day, patients have the most access to their medicines at a reasonable cost. I am convinced PBMs influence the price of the cost of medicines we have in Puerto Rico.”

The PAO, represented by attorney Emilio Ruiz, concurred with the bill’s motives in that it should be the state that regulates PMBs and PBAs.

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In addition, he mentioned that 80 percent of complaints received by the PAO are related to the denial of medication. “Many of the reasons for these complaints [are about] insurers not wanting to pay the high cost for the drug because, sometimes, the price of a drug can change drastically from one month to another,” he added.

These complaints are referred to as requiring “immediate action” because they must be resolved within 24 hours, since health, and even the life of the patient, depend on timely drug consumption. The PAO emphasized to the committee that it should be in charge of addressing and processing those complaints.

Víctor Ramos, president of the Puerto Rico Physicians & Surgeons Association, endorsed the creation of the Regulatory Commissioner’s Office and the position of a regulating commissioner for PBMs and PBAs, but said the bill “omits issues regarding the interests of doctors and patients.”

Also present at the hearings was Elda Sierra, chairwoman of the Puerto Rican Pharmacies Cooperative (Coopharma), who favors SB 218 and declared that “our patients’ access to health is necessary through the regulation and supervision of a business sector that is deregulated in terms of its practices and operations on the island.”

However, Vilmarie Sepúlveda, special assistant & deputy director of the Health Department’s legal division, hesitated recommending approval of the bill and preferred to grant its oversight authority to the Insurance Commissioner’s Office.

Meanwhile, Ángela Ávila, executive director of the Health Insurance Administration (ASES by its Spanish acronym), said “ASES does not oppose balanced, clear regulation that prevents a negative impact on the health plan of the government of Puerto Rico or its beneficiaries. However, we call attention to the bill as presented because it contains several aspects that worry us and deserve greater consideration and analysis.”

Before concluding the public hearing, Morales said new legislation will be introduced to investigate compliance with the government’s health plan regarding the required delivery of medications in less than 48 hours. “We know there are many patients who aren’t receiving their medications within the stipulated time period,” he added.

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