Minnesota Senate Republicans targeted middlemen in the health care system — insurers and those who process prescription drugs — as they debuted a plan Wednesday aimed at reducing health care costs.

Pharmacy benefit managers, who have a role in determining drug costs and which drugs a patient gets at the pharmacy, need to be better regulated, said Republican Sen. Scott Jensen, a doctor from Chaska. He wants pharmacy benefit managers to be licensed, disclose conflicts of interest and expand pharmacy networks to provide access across the state.

"Pharmacy, literally, is a parasite with an insatiable appetite and if we don't step in we're not going to be able to fix it," Jensen said.

That idea could have big bipartisan support, said Sen. John Marty, the ranking Democrat on the Health and Human Services Committee. But the pharmaceutical industry has a lot of control in the Capitol, he said, and he's worried this initial backing will fade.

Marty supports universal health care and said some of the changes Republicans offered Wednesday are "minuscule," but added that they could be helpful for certain people. The one major piece was the pharmacy benefit managers rules, he said.

"I want to see if we can break open the pharmaceutical pricing thing … where some customers pay some things and others pay others, and nobody knows what anybody else is paying," he said. He hopes to work with legislators and Attorney General Keith Ellison to end that.

Minnesota would not be the first state to add more regulatory oversight for pharmacy benefit managers. California recently passed a similar law.

Other pieces of the Minnesota Senate Republicans' plan included giving patients the "right to shop" for a good deal with out-of-network doctors and affirming that people with pre-existing conditions would be protected.

The senators also supported direct primary care. Patients could get more affordable health care with less red tape under that system, where they pay a flat monthly fee to their doctor rather than going through an insurance company, the senators said.

"You take that insurance company out of that whole mix. So when you do that, that frees up time and increases the relationship," said Republican Sen. Mary Kiffmeyer, a former nurse from Big Lake. "All those middle things have cost. You remove that, now it's direct from the physician."

Direct primary care allows physicians to spend more time connecting with their patients, said Sen. Michelle Benson, R-Ham Lake, but added that it doesn't mean insurance is not necessary.

"We don't want to undermine the importance of insurance," she said. "You need that for catastrophic care or if you have a difficult, complex chronic disease or multiple issues."

Jessie Van Berkel • 651-925-5044