At the drug store, the price per pill can be enough to make you sick.

On Tuesday, state lawmakers pushed for a crackdown on pharmacy benefit managers, the middlemen who negotiate prices and formularies between drug makers, pharmacies and health insurers.

But PBMs warned that a new law could backfire, leading to even higher prices for patients.

PBMs have a huge influence over which drugs patients have access to – and how much they pay. Insurance carriers use them to create formulary lists and negotiate prices.

The idea is to lower costs, but Connecticut lawmakers said PBMs are actually doing the opposite.

“Everyone in health care is making profit off the high price of drugs, except the patient,” said state Sen. Matt Lesser (D-Middletown). “A PBM will demand a rebate from a drug company, and so they’re going to steer folks sometimes to the most expensive drugs because they get the most rebates there.”

In January, the Federal Trade Commission accused three pharmacy benefit managers of pocketing billions in rebates for cancer, HIV, heart disease and multiple sclerosis drugs.

“They were marking up their pharmacies by hundreds or thousands of percent,” Lesser said.

Lawmakers are considering a bill that would prevent benefit managers from steering health insurers to more expensive drugs, just because they offer bigger rebates. PBMs would also be classified as fiduciaries who must disclose conflicts of interest and act in the best interest of insurance carriers.

Plus, insurers would pay what the PBM pays for medications – nothing more.

“I understand companies make money, but when you see these huge profits that are not rolling down or help lower the costs, that's a problem,” said state Sen. Jeff Gordon (R-Woodstock), who is also a doctor. “I’m not saying getting rid of the PBMs, but we really need to make certain that they're transparent.”

The bill would also explore importing cheaper prescription drugs from Canada, which is part of Gov. Ned Lamont’s proposal to tie generic drug prices to inflation. But importing drugs would require federal approval, which could be a long shot given the current trade war with Canada.

A bipartisan task force on lowering prescription drug prices crafted the recommendations.

PBMs blame pharmaceutical companies for high list prices.

“This bill does nothing to lower the cost of drugs set by pharma,” said Sam Hallemeier with the Pharmaceutical Care Management Association, a PBM industry group. “Here I am right now, pleading and begging for pharma to lower their prices. They alone have the ability to do so.”

Hallemeier, who was part of the state task force, estimated that the bill could cost patients $301 million in higher premiums next year.

Insurance carriers also believe the law could actually raise drug costs by taking away the flexibility to negotiate the lowest possible price.

“Rebates are typically used to lower overall premiums and spread savings across all members of a health plan,” the Connecticut Association of Health Plans testified. “Attempts to mandate point-of-sale rebate pass-throughs concentrate savings on those taking high-cost drugs, while shifting costs onto the broader pool of insured members through higher premiums.”

The General Assembly’s Human Services Committee has until March 20 to act on both proposals. They are likely to undergo changes after Tuesday’s public hearing.

Click HERE to submit written testimony.