Healthcare advocates are celebrating legislative victories in the Maine Legislature, including a $35 cap on insulin costs and expanding Medicaid coverage for dental services to adults, reports The Press Herald. Additionally, the legislature passed bills that extend Medicaid coverage twelve months postpartum and sets the minimum wage for direct care workers, such as those who provide home-based healthcare services, to 125 percent of the minimum wage. However, Governor Mills vetoed bills aiming to reduce prescription drug costs that would have outlawed price gouging and required drug manufacturers to justify price increases.
Some private insurance companies in Colorado will soon be required to offer a state-regulated health insurance plan, reports the Colorado Sun, now that the governor has signed House Bill 1232. Insurance companies will be required to offer it in 2023 at a cost reduction of at least five percent, and the total reduction must meet 15 percent starting in 2025. The governor also signed Senate Bill 175, which creates a five-member Prescription Drug Affordability Board that will have the authority to cap the price of prescription drugs that the panel determines are too expensive. The Board is also tasked with making policy recommendations to state lawmakers on how to make prescription drugs more affordable.
Montana recently passed a law, SB 374, that would allow all Montana physicians, starting in Fall 2021, to dispense medications they prescribe to patients, not just those whose offices are at least 10 miles away from a pharmacy, reports U.S. News and World Report. The new law requires physicians who dispense medication to be regulated like a pharmacy and requires opioids to be dispensed by pharmacies. Another new law, SB 395, aims to reduce prescription drug prices by allowing the state to regulate pharmacy benefit managers. The Governor hopes that by increasing transparency and oversight of the middlemen in the pharmaceutical supply chain, the state will bring generic drugs to market faster, increase pricing transparency and promote accountability.
Minnesota adults face high levels of healthcare affordability burdens, reports AboutHealthTransparency.org. A survey of more than 1,070 Minnesota adults, conducted by Altarum's Healthcare Value Hub from Oct. 30, 2020 to Nov. 27, 2020, found that more than half (51%) experienced healthcare affordability burdens in the past year. In addition, even more are worried about affording healthcare in the future and high numbers are worried about becoming ill from the coronavirus. The survey also revealed regional differences in how Minnesota adults experience healthcare affordability burdens. Fifty-seven percent of residents in the Southern region face these burdens, the highest in the state, and 51% of Southern region adults reported skipping a recommended medical test or treatment due to cost. Forty-one percent of Twin Cities Metro area residents, by comparison, reported doing the same.
The Maryland House of Delegates has overridden the Governor’s 2020 veto of a Prescription Drug Affordability Board, enabling plans for the Board to proceed, reports STAT+. In January, the Senate also overrode the veto, which the Governor had issued over concerns that the move would raise taxes and fees at a time when the COVID-19 pandemic had already hurt citizens. The Board is designed to function like rate-setting boards that regulate what public utilities can charge residents, with supporters arguing that the board can save consumers money by lowering prescription drug costs. What sets the PDAB apart from other state efforts to rein in costs is that it can, if determined to be in the best interest of the state, make a recommendation to the Maryland General Assembly to pursue upper payment limits to make drugs affordable. If the Board makes this determination, it will first develop a plan of action for review and approval by the Legislative Policy Committee. Maine has also enacted a law creating a board. Although rather than setting upper payment limits for medicines, the board established a spending target for public payers and seeks to leverage public purchasing power to meet its target.
Lehigh County could have saved roughly $1.4 million for prescription drugs in 2019, reports Stat+. The Office of the Controller’s report found that rebates negotiated by pharmacy benefit managers were frequently pocketed by the insurance company as profit, rather than credited to the county. In addition, the office identified 200 prescription drugs that were available at lower prices from competitors. The office recommended pursuing comparative prescription drug pricing for the 200 drugs and receiving the full value of prescription drug and medical claim rebates from the insurance company to save the county money.
Colorado is now soliciting vendors to implement the state’s Canadian Drug Importation Program, reports CBS Denver, and anticipates awarding vendor contracts later this year. The program is designed to give Coloradans access to Canada’s lower-prices drugs and was made possible through a change in federal policy enacted in November 2020, which allows FDA-authorized programs to import certain prescription drugs from Canada. A recent report from the Colorado Department of Health Care Policy & Financing posits that the average savings on importable drugs could be more than 60 percent, but savings for some drugs was greater than 90 percent.
A new report from the Colorado Department of Health Care Policy & Financing found that specialty drugs represented less than two percent of drugs prescribed to patients in Colorado but accounted for almost 50 percent of total prescription drug expenditures, reports State Network. Additionally, the report on reducing prescription drug costs found that rebates paid to middlemen such as PBMs and insurance carriers are often retained as profits. Proposed solutions include creating an affordability board to study prescription drug prices, passing along rebates and savings to employers and consumers and increasing transparency in prices, profits and rebates.
A U.S. District Court judge in the Eastern District of California upheld the state’s drug price transparency law, challenged by the Pharmaceutical Researchers and Manufacturers of America (PhRMA), reports NASHP. The law requires manufacturers to report and provide information about certain drug price increases and give 60-day advance notice of drug price increases if the list price is more than $40 and if the price increased more than 16 percent over the past two years. The ruling is a legal victory for states working to curb drug prices following the Supreme Court’s December 2020 decision to uphold an Arkansas law regulating pharmacy benefit managers.
The U.S. Supreme Court upheld Arkansas’ law regulating pharmacy benefit managers (PBMs), ruling that it is not preempted by ERISA, reports Fierce Healthcare. Arkansas’ law prohibits PBMs from reimbursing pharmacies at lower rates than the cost required to dispense prescriptions and allows pharmacies to refuse to sell a drug if the upper limit that plans will pay for it is too low. Opponents of the law argue that it increases costs for patients and could potentially result in pharmacies not carrying needed medications; proponents argue that the law protects rural and independent pharmacies from too-low reimbursement rates. The ruling paves the way for other states to pass laws regulating PBMs and explore other cost-regulating measures.
Cancer and rheumatoid arthritis brand-name drugs continue to be the most expensive for Oregon residents, according to new data from the Oregon Division of Financial Regulation. For the second year in a row, the brand-name drug Humira, commonly used to treat rheumatoid arthritis, was the costliest prescription drug reported by Oregon’s health insurance companies, as well as the most prescribed specialty drug. Glatiramer, used to treat multiple sclerosis, was the most expensive generic drug reported, costing insurance companies approximately $2,800 per prescription. To determine what insurers paid on average for each prescription and to identify the most expensive prescriptions, the program team examined claims data for drugs prescribed to 10 or more enrollees and compared the total dollars spent by insurers to the corresponding prescription counts for each drug.
California’s governor signed legislation meant to bring down the cost of prescription drugs for taxpayers, employers and consumers, according to a press release from the governor’s office. The first-in-the-nation law tasks the California Health and Human Services Agency (CHHS) with developing manufacturing partnerships to produce or distribute generic prescription drugs, thereby increasing competition in markets that have driven up prices for consumers and helping address critical drug shortages. CHHS will focus on manufacturing drugs that could produce the biggest cost savings and will submit a report to the legislature analyzing how its efforts have impacted competition, access and costs for those drugs.
The presidential administration announced a rule allowing the importation of some prescription drugs from Canada, clearing the way for Florida and other states to implement programs to bring medications across the border, according to Kaiser Health News. Florida’s law—approved in 2019—would set up two importation programs. The first would focus on getting drugs for state programs such as Medicaid, the Department of Corrections and county health departments. The second program would be geared to the broader state population. Prices are cheaper in Canada due to limitations on how much pharmaceutical companies can charge for medicines. State officials said they expect the program to save the state about $150 million annually. The rule, however, does not allow states to import all types of medications, including biologic drugs such as insulin.
Proposed legislation in Pennsylvania would allow the state to set payment rates for high-cost prescription drugs equivalent to prices in Canada, where prescription drugs can cost as much as 80 percent less than in the U.S., reports NASHP. This model would reduce prices for 250 high-cost drugs identified by the state, hold drug manufacturers more accountable and result in significant savings for both patients and states. If a drug manufacturer refuses to comply or withdraws their drugs from the market, they will have to pay significant penalties to the state.
California is poised to become the first state to develop its own line of generic drugs after the legislature overwhelmingly approved a measure directing the state’s top health agency to partner with drug companies to make or distribute a broad range of generic or biosimilar drugs that are cheaper than brand-name equivalents, reports Kaiser Health News. Though it could take years to successfully bring new generic products to the market, the move would put the state in direct competition with major generic and brand-name drug manufacturers that dominate the market, and potentially allow California to use its massive purchasing power to drive down drug prices.
A 2016 New Jersey law gave the state flexibility to share bid information submitted by all pharmacy benefit managers (PBMs) in order to incentivize them to submit lower offers in additional bidding rounds – known as a reverse auction. This approach was implemented in 2017 and is now projected to save $2.5 billion in drug spending for public employees between 2017 and 2022, according to NASHP. Several other states have followed New Jersey’s lead, with Maryland approving legislation to conduct reverse auctions for PBM procurement in 2020 and the New Hampshire State Senate passing similar legislation (however, the House suspended consideration of the bill in late June 2020).
Mental health drugs now account for a fourth of all pharmacy spending by private insurance and about a third of pharmacy spending by public payers, such as Medicaid. Spending is expected to increase 60 percent over the coming decades, according to a CMS prediction cited by the Clarion Ledger. This will have a large impact in Mississippi, where approximately 77,000 Medicaid beneficiaries had behavioral health diagnoses (a number that includes children but not infants) in state fiscal year 2019. Restricting access to needed medications can be detrimental in the long run— “69 percent of patients with medication access problems had adverse events compared to 40 percent for patients with no access problems,” according to Joyce West, director of the American Psychiatric Research Network.
Half of New Jersey adults experienced problems affording healthcare in the past year and three-fourths worry about affording it in the future, according to the latest Consumer Healthcare Experience State Survey by the Healthcare Value Hub. In a press conference consumer advocates from New Jersey, a patient facing high drug costs, U.S. Senator Cory Booker and New Jersey Assemblyman John McKeon all spoke on the issues of high drug costs facing their communities and constituents. Assemblyman McKeon has sponsored a bill to create a Prescription Drug Affordability Review Board, reports New Jersey 101.5, to meet every six weeks, evaluate drug prices and set limits on how much payers pay for high-cost prescription medications – a policy that received widespread bipartisan support in the Hub’s New Jersey survey.
PhRMA, the drug industry lobbying association, sued the state of Minnesota over a newly enacted law meant to prevent people who cannot afford their insulin from rationing it, reports STAT News. The Alec Smith Emergency Insulin Act allows Minnesotans who would otherwise forgo their insulin to immediately pick up a 30-day supply of the drug from a pharmacy for $35, while drug makers would be forced to provide the insulin for free or face hefty fines. PhRMA is seeking a permanent injunction that would prevent the law from going into effect.
Delaware, Maryland and Louisiana laws implementing out-of-pocket price caps for expensive specialty drugs reduced patient spending on these medications by $351 per month, according to a study published in The New England Journal of Medicine. Although the laws resulted in a 32 percent decrease in spending for patients in need of these drugs, they did not lead to any changes in health plan spending per patient. The study highlighted that health plan spending for specialty drugs has increased from approximately 26 percent of total drug spending to 49 percent in the past 10 years, even though these medications make up less than 2.5 percent of prescriptions overall
The Connecticut General Assembly passed legislation that will cap the monthly cost of insulin, supplies and emergency insulin for people with insurance, according to the CT Examiner. Beginning Jan. 1, 2022, the maximum monthly out-of-pocket cost for insulin will be $25, while non-insulin medication and devices/equipment will cost $25 and $100, respectively. Additionally, anyone with diabetes will be eligible for a 30-day emergency supply of insulin at any pharmacy in the state one time per year. The law is a major win for roughly 25 percent of patients with diabetes who report rationing insulin because of cost.
Following a handful of other states, New Hampshire has passed a law to set up prescription drug importation programs with Canada, reports Healio News. The omnibus bill also puts a $30 price cap on monthly insulin copays for those with state-regulated commercial health insurance. Proponents of the measure believe it will create transparency in drug pricing and help New Hampshire residents get access to lower-cost prescription drugs, namely insulin.
Understanding how prescription drug prices are set will allow both patients and states to make more informed decisions about whether prices are excessive, as well as introduce some rationality and evidence into the healthcare system, according to a new report from the West Virginia Center on Budget and Policy. During the 2020 legislative session, West Virginia passed a drug transparency law requiring manufacturers to report prices, and research and development costs and justify price increases. In addition, all health plan insurers in the state are required to report the 25 most frequently prescribed prescription drugs, the percent increase in annual net spending for prescription drugs, and the percent increase in premiums that were attributable to prescription drugs. Authors note that the state could consider expanding the law to include pharmacy benefit managers and appointing a prescription drug affordability board with the power to regulate drug prices.
Utah is implementing an insulin cost savings program that will allow every Utahn to purchase insulin at a 60 percent discount through the state Public Employee Health Plan (PEHP), according to KUTV. PEHP will purchase insulin at a higher rate, but Utahns will only have to pay the wholesale cost—about a 60 percent discount. The law also caps health insurance copays for insulin at $30 for a 30-day supply. Additionally, this law enables pharmacists to dispense a 90-day supply of insulin on an emergency basis for patients having difficulties with their prescription.
A coalition of 51 states and territories, led by Connecticut’s attorney general, are suing generic drug companies for price fixing, according to a press release from the attorney general’s office. The lawsuit stems from the ongoing antitrust investigation into a widespread conspiracy by generic drug manufacturers to artificially inflate and manipulate prices, reduce competition and unreasonably restrain trade for generic drugs sold across the United States.
The Governor of Maryland has vetoed a measure to fund the state's fledgling Prescription Drug Affordability Board, reports Maryland Matters. Senate Bill 669 and House Bill 1095 would set up a funding source for the panel, which was created in 2019 and began meeting for the first time in 2020. The board was established by lawmakers to identify ways to reduce the cost of prescription drugs. Though the funding was vetoed, the 2019 legislation that created the board guarantees it will receive state funds in the form of a loan on July 1. The board has until December 31 to identify a way to fund its operations and to repay the loan from the general fund starting next year.
In the past six months, California state authorities have fined more than a dozen drug makers a total of $17.5 million for failing to report price hikes as required by law, according to STAT. The fines underscore an ongoing struggle between the state and the pharmaceutical industry over disclosing price increases, an issue that has galvanized consumer advocates and lawmakers around the country as they seek to control prescription drug costs. The California law requiring drug makers to provide advance notice of price hikes and explain the reasons for any increases, implemented in January 2019, has served as a model for other states exploring ways to respond to rising drug prices.
The Governor of Minnesota signed into law the Alec Smith Insulin Affordability Act to provide relief to residents struggling to afford their insulin, reports the Office of the Governor. The bill contains emergency and long-term components, which take effect on July 1, 2020. The emergency provisions allow eligible individuals in urgent need of insulin to go to their pharmacy once in a 12-month period and receive a one-time, 30-day supply of insulin for a $35 co-pay. The long-term program requires manufacturers to provide insulin to eligible individuals for up to one year, with the option to renew annually. Insulin will be available in 90-day increments for a co-pay of no more than $50.
Despite an abbreviated legislative session, the Maryland General Assembly approved permanent funding for the Prescription Drug Affordability Board, reports AARP. The Board has the authority to require that pharmaceutical manufacturers justify large price increases. The Board’s scope will focus on implementing measures to make prescription drugs purchased by state and local government entities and programs more affordable, and to present a plan to the legislature to expand its authority in the future.
The Governor of New Mexico signed four significant public health bills designed to reduce the high cost of prescription drugs and develop more affordable healthcare insurance options, the office reported in a press release. Of note is House Bill 292, which caps co-pays and out-of-pocket expenses for insulin at $25 per prescription for a 30-day supply – making them the lowest in the country. Also, House Bill 100 empowers beWellnm, the New Mexico health insurance exchange, to operate as a fully state-based exchange meeting the needs of families seeking health insurance coverage in New Mexico and promoting access to more affordable, higher-quality insurance plans.
Colorado has embarked on numerous healthcare reforms this year, reports Global Health News Wire. Major initiatives include creating the Office of Saving People Money on Healthcare, passing a reinsurance bill to sheild insurance plans form the costs of their sickest patients, initiating surprise billing protections, capping copays for insulin, and authorizing the Polis administration to develop a public option proposal. Though there is industry pushback to these initiatives from hospitals and insurers, there is no doubt that Colorado is ahead of the curve in healthcare initiatives.
Oklahoma’s Attorney General has joined a bipartisan coalition of 46 attorneys general from across the country filing an amicus brief in the U.S. Supreme Court that supports the authority of the states to address the rising cost of prescription drugs, reports FOX25. The brief supports a law proposed by the state of Arkansas in 2015 that sought to require pharmacy benefit managers (PBMs) to raise their reimbursement rate for a drug if the rate were to fall below the pharmacy's wholesale cost.
The Govenror and Lt. Governor of Colorado released an updated 2020 Roadmap to Savings Coloradans Money on Healthcare to reflect the progress made over the last year to lower healthcare costs for state residents. The updated roadmap notes some major inroads, including: an average reduction of 20.2 percent statewide in insurance premiums on the individual market, the design of a state public insurance option, and the establishment of a Behavioral Health Taskforce. The 2020 Action Items that the Office of Savings People Money on Health Care seeks to advance include adopting a state public insurance option, extending the state's reinsurance program, launching a statewide purchasing alliance, and launching a Prescription Drug Affordability Board.
In a major victory for consumers, a federal judge in Kansas City, Kansas, is allowing a lawsuit over EpiPen price hikes to move ahead, according to KCUR. The lawsuit will determine whether drugmakers sought to monopolize the EpiPen market after they dramatically hiked the price of the device, triggering consumer fury and a congressional investigation. The judge’s ruling also allows consumers to sue for damages under state antitrust laws.
Ohio’s Prescription Drug Transparency and Affordability Advisory Council, a panel of government, business and consumer advocates exploring ways to ensure that pharmaceutical drugs, has convened to discuss their recommendations for the state’s governor, according to the Times Reporter. Ohio currently spends about $3.5 billion a year on prescription drugs for state employees, injured workers, Medicaid beneficiaries, incarcerated prisoners and others. The Advisory Council is considering bulk purchasing and price transparency strategies..
A majority of Illinoisans have had difficulty affording healthcare and prescription drugs in the past year, according to a new study by Consumer Healthcare Experience State Survey. According to a recent Health News Illinois article, Rep. Will Guzzardi unveiled a proposal that would create a new state board that would review data on drug prices and set new payment limits for state-regulated plans. This CHES Survey was commissioned by Protect Our Care Illinois and Altarum’s Healthcare Value Hub.
According to a new Altarum survey, 81 percent of residents say they are “worried” or “very worried” about being able to afford some aspect of healthcare in the future, such as prescription drug costs and health insurance. WTTW reports that Illinois residents have continuously reported concern about rising healthcare costs, and how they will pay for them in the future.
The Minnesota Attorney General unveiled a task force report that makes 14 recommendations for lowering prescription drug prices, ranging from new legislation to stronger enforcement, according to the Crookston Times. The 14 recommendations mentioned in the report fall into three broad categories: to make the markets work better for consumers; to use the government’s purchasing power to make drugs more affordable and accessible; and to require more transparency and accountability in the market.
The California Health Care Foundation released its second annual California Health Policy Survey, identifying mental health, the provider workforce, and lowering prescription drug prices as top priority issues for Californians, reports State of Reform. Healthcare affordability continues to be a primary concern, with more people reporting that they are worried about unexpected medical bills, out-of-pocket costs for health services and prescription drug costs compared to last year. There is also an increase in the number of people who skipped or postponed care due to cost.
Just 10 treatment categories of drugs, including anti-asthmatic, cardiovascular and antiviral, accounted for over 70 percent of Massachusetts pharmacy claims from 2015 to 2017, according to MassLive. These statistics are available in a report on prescription drug use and spending from the Center for Health Information and Analysis (CHIA), an independent state agency that monitors the performance of Massachusetts’ healthcare system. The report found that anti-inflammatory tumor necrosis factor inhibiting agents, like Humira and Enbrel, which are used to treat difficult-to-manage diseases like rheumatoid arthritis, accounted for the largest portion of spending.
A new Illinois law will cap out-of-pocket insulin costs at $100 for a 30-day supply, according to WGN9. The new legislation (SB 667) is expected to impact about 1.3 million people in the state who have diabetes and is considered an important step in lowering out-of-pocket costs for Illinois families.
California’s governor unveiled a proposal to make California the first state to sell its own generic prescription drugs to increase competition in the state's generic drug market, according to Advisory Board. The governor also proposed establishing a single market for drug pricing in California, among other strategies to lower costs. Health policy experts believe that California is ripe for testing these concepts at a government level, but California's Legislature will have to approve the proposals before the state can implement them.
The U.S. Supreme Court will hear a case that could decide the validity of at least 38 states’ laws regulating how companies like Express Scripts and CVS Health make money off prescription drugs, reports Bloomberg Law. The justices agreed January 10 to take a case asking whether an Arkansas law regulating pharmacy benefit managers is preempted by the federal Employee Retirement Income Security Act. The Pharmaceutical Care Management Association, a trade group representing PBMs, successfully challenged the law on ERISA preemption grounds in the Eighth Circuit. The court’s decision to hear the case came at the urging of U.S. Solicitor General, who argued that the Arkansas law doesn’t reference ERISA plans or have an impermissible connection with them.
The governor of Vermont submitted a concept paper to the federal government outlining the state’s approach to implementing the first-in-the-nation drug importation law, according to NASHP. Unlike an earlier submission from Florida that proposes a wholesale importation plan to benefit public programs, Vermont’s plan includes all commercial health plans and is designed to benefit all state residents, not just those on public programs. Vermont proposes to assure consumer savings through a number of vehicles, including lowering premiums and deductibles, and reducing or eliminating copays on imported drugs.
Legislation aimed at overhauling Massachusetts’ healthcare system was introduced this month, according to the Boston Globe. Among other things, the legislation would require an increase in spending by hospitals and insurers of 30 percent over three years for primary care and behavioral health, without increasing overall spending. This move to reshape the delivery of services reflects the concern that less than 15 percent of total medical expenses are spent on primary care and behavioral health combined. In addition, this legislation would streamline the behavioral health provider credentialing process. Also of note, this legislation would seek to create more extensive state oversight of drugs that cost over $50,000 per person per year, even if bought through the private market.
California enacted a first-in-the-nation state law to combat pay-for-delay deals, in which brand-name pharmaceutical manufacturers pay a generic competitor to settle patent litigation and keep a lower-cost version of the drug off the market, reports NASHP. Delaying market entry of generic drugs can keep prices for brand-name drugs high, costing California consumers an estimated $3.5 billion in higher drug costs each year.
With enrollment for Minnesota’s health plans set to begin, many are watching to see the effects of insurers’ recent announcements of insulin out-of-pocket caps, according to the Star Tribune. Those who purchase coverage through MNsure or from Medica and UCare will have their out-of-pocket spending on each insulin prescription capped at $25 per month, regardless of annual deductibles. When asked, insurance companies have explained that an amendment in the state’s recent omnibus healthcare spending law makes it illegal for Minnesota insurers to profit from selling insulin. Consumers who use insulin note that it is an important necessity for them, but that other medical necessities are still expensive, like insulin pumps and glucose monitors.
The Michigan Department of Health has proposed removing pharmacy benefit managers (PBMs) from overseeing prescription drug claims and negotiating prices for the state’s Medicaid program in a hope to save Medicaid dollars, according to Modern Healthcare. The department expects the proposal will save the state about $40 million, streamline administrative processes and ensure uniform drug coverage for Medicaid enrollees. Other states have stopped outsourcing prescription drug services to PBMs after studies found that PBM prices often exceed Medicaid fee-for-service drug prices. While PBMs defend their practices by stating that they address high drug prices by negotiating payment rates from pharmaceutical companies by leveraging formularies and utilization management tools; critics assert that PBMs have an incentive to prioritize high-priced drugs over more cost-effective alternatives.
Nevada is imposing $17.4 million in fines on 21 diabetes drug manufacturers that have either failed to comply with or were many months late in complying with a drug pricing transparency law passed two years ago, reports The Nevada Independent. The law, which was passed by the Legislature in 2017, requires diabetes drug manufacturers to annually report to the state production costs, administrative expenditures, profits, financial assistance, coupons, and other information. It also requires manufacturers to provide additional information for drugs determined to have experienced a significant price increase, including a list of each factor that contributed to the increase and the percentage of the total increase attributable to each factor
As health plans prepare to submit rate filings, a new report from Oregon’s Division of Financial Regulation’s Prescription Drug Price Transparency Program illuminates just how much prescription drug prices impact insurance premiums. Oregon requires health plans to report on: per member, per month (PMPM) drug costs; top 25 drugs responsible for the greatest increase in planning spending; top 25 most costly prescription drugs; and the top 25 most frequently prescribed medications. Based on 2018 data, on average, drug costs represented 14 percent of premium rates in Oregon. Abbvie’s Humira, a biologic used to treat various autoimmune diseases, topped the list as both the most costly and the largest contributor to increases in plan spending.
Air ambulance companies have begun advertising memberships to rural Kansans in the wake of recent hospital closures, prompting concerns that the companies are exploiting vulnerable patients, reports KCUR. Although the membership programs promise to protect customers from out-of-pocket expenses, the contractual fine print often undermines the advertised intent. For example, privately insured patients who purchase memberships would still receive a bill and must work through their insurance company’s claims, denial and appeal processes. Additionally, air ambulance companies can end memberships at any time without obligation to notify the customer. North Dakota and Montana ban or heavily regulate the memberships in attempt to better protect consumers.
Blue Cross Blue Shield of Minnesota announced that they will cover insulin costs next year with $0 co-pay, according to Alpha News MN. The insurance company's CEO cited the skyrocketing costs of insulin as a reason for the measure, which have risen by over 300 percent, noting that their first responsibility is to improve the health and financial stability of their members. Previously, Minnesota Medical Insurer Medica and UCare announced that they will cap insulin costs at $25 a month.
The Nevada Department of Health and Human Services is threatening to levy roughly $20 million in fines on more than two dozen drug manufacturers that have yet to submit cost and profit reports to the state as required by a law aimed at better understanding the rising costs of treating diabetes, reports The Nevada Independent. Under the 2017 diabetes drug transparency law, the annual reports are required to include production costs, administrative expenditures, profits, financial assistance, coupons, and other information in an effort to better understand why the disease is so costly to treat. Manufacturers are also required to provide to the state additional information for drugs determined to have experienced a significant price increase, including a list of each factor that contributed to the increase and the percentage of the total increase attributable to each factor.
The Governor of Wisconsin, through an executive order, created a task force focused on reducing prescription drug prices in Wisconsin, according to WEAU News. The Governor's Task Force on Reducing Prescription Drug Prices is charged with gathering and analyzing data on development, pricing, distribution and purchasing of prescription drugs, analyzing other states' strategies in reducing prescription drug prices and identifying opportunities to work with other states and the federal government. The Task force is also charges with making recommendations for reducing prescription drug prices in Wisconsin.
Horizon Blue Cross Blue Shield – New Jersey’s largest health insurance company – has developed a software tool that enables prescribers to get quick access to a list of lower-cost drug options tailored to address a patient’s unique needs and definitively covered by their specific prescription drug plan, according to NJ Spotlight. The rising price of prescription drugs has triggered problems for patients and their physicians: high out-of-pocket costs can lead individuals to skip or ration their medications. The pilot, launched in April, has since spread to some 5,000 prescribers, with Horizon hoping to double that usage by the end of 2019.
After an audit revealed that a 8.8 percent spread between what pharmacy benefit managers (PBMs) charged Medicaid managed care plans and what they paid to pharmacies, Ohio Medicaid directed managed care plans to end their contracts with pharmacy benefit managers, effective January 2019. Plans were instead asked to adopt a transparent “pass-through” pricing model whereby the managed care plan would pay the PBM the exact amount paid to the pharmacy for the prescription drug, a dispensing fee, and, in lieu of spread-based revenue, an administrative fee, according to JAMA. Ohio policymakers also pursued the prohibition of gag clause by PBMs, which prevent pharmacies from sharing with patients the most cost-effective option when purchasing medications. Uniquely among states, Ohio’s approach includes assessing the potential effect of these reforms on outcomes and evaluating gains after reform implementation.
The Colorado legislature passed numerous bills in the healthcare space that primarily focused on reducing the cost of care for consumers and improving accountability for quality care, according to the National Law Review. Some of these laws include HB 19-1174, which requires insurance carriers, providers and facilities to begin providing patients with information on the potential impact of receiving services from an out-of-network provider, prohibits “balance billing” patients who receive covered services from out-of-network providers at an in-network facility or emergency services from out-of-network providers or facilities, and establishes the reimbursement amount insurance carriers must pay to out-of-network providers that provide health care services to covered persons at an in-network facility or out-of-network providers for emergency services. HB 19-1131 requires that manufacturers and their representatives provide information about the wholesale acquisition cost of a prescription drug when providing information to a health care provider licensed to prescribe controlled substances or prescription drugs, and that when providing wholesale prescription drug price information, the manufacturer and representatives must also provide a list of at least three generic prescription drugs from the same therapeutic class and their wholesale acquisition costs. HB 19-1320 requires certain hospitals to complete an annual community health needs assessment and annual community benefit implementation plan.
Florida has enacted several healthcare laws geared towards affordability. One such law would allow health insurance companies to work with providers — like hospitals — to setup a website with lists of shoppable, non-emergency services such as lab work or outpatient surgical procedures, according to Florida Voices for Health. Another bill would establish a Canadian drug-import program for state healthcare coverage, which includes 3.8 million Medicaid recipients and 100,000 state prisoners.
Florida has passed legislation authorizing the state to import prescription drugs from Canada and other countries, potentially lowering the cost of lifesaving medicines that millions of people take every day, according to AARP. The law creates two prescription drug importation programs: The Canadian Drug Importation Program focuses on bringing down the cost of drugs to state-funded programs, such as Medicaid and the state prison system; and The International Prescription Drug Importation Program allows medicines to be imported from Canada and other countries, and then purchased by consumers through wholesale distributors and pharmacies. In order to implement these programs, states need approval from the U.S. Department of Health and Human Services (HHS) to begin their programs.
Vermont is eyeing birth control, insulin and pricey medications for HIV and multiple sclerosis as possible candidates for the state's landmark program to import cheaper drugs from Canada, reports Politico. State officials determined that the importation program could save insurers up to $5 million annually, based on this list of drugs, which the state has yet to finalize. A potential barrier is that Vermont must prove that the importation program wouldn’t pose additional risks to patient safety and that consumers will pay less for drugs under the new model in order to receive approval from HHS. HHS set up a working group last summer to study importation, but many of the details have been kept secret.
A new West Virginia will enable residents to access life-saving medicines when their supply runs out, the prescription is expired and the doctor can’t be reached to 'OK' it, according to WV Metro News. HB 2524 grants pharmacists the discretion to fill those prescriptions under specified conditions and certain circumstances. This bill allows pharmacists, under specified conditions, to extend 30-day prescriptions to 90 day and requires payers to cover the cost if it is consistent with the patient's benefit plan.
Wisconsin Medicaid’s 2014 coverage expansion had a tremendous impact on making antidiabetic drugs more affordable for childless, low-income adults, according to the University of Wisconsin-Madison News. The study, published in Health Affairs, revealed that before the expansion, this population was covered by the BadgerCare Plus Core Plan, which covered fewer medications and had higher copays for generic and brand-name drugs. The expanded coverage was also correlated with a 4 percent increase in childless adults using antidiabetic medications, such as insulin and oral medications.
A first-in-the-nation measure in Maryland to create a prescription drug affordability board will become law without the Governor’s signature, according to The Associated Press. The law creates an independent board with the authority to evaluate expensive drugs and recommend methods for addressing high costs. The measure was scaled back significantly from an initial proposal. For one thing, it will only apply to state and local governments, not all Maryland residents. Also, the board could only set upper-payment limits with approval from a legislative panel beginning in 2022.
Colorado Governor Jared Polis signed legislation that caps insurance co-payments on insulin at $100 a month, no matter the type of insulin. According to The Denver Post, the measure goes into effect in January and insurers are expected to pay the difference in price. The cost of insulin has continued to increase in the U.S., with prices doubling since 2012.
Missouri and Kansas have joined 41 other states and Puerto Rico in a lawsuit accusing generic drug makers of conspiring to manipulate and drive up prices for more than 100 generic drugs, reports KCUR. The lawsuit, filed in federal court in Connecticut, alleges that generic drug giant Teva Pharmaceuticals significantly raised prices on more than 100 generic drugs beginning in July 2013 and colluded with competing companies to carve up markets and raise prices on at least 86 of those drugs. Missouri’s Attorney General called the alleged conspiracy “one of the most damaging and far-reaching price fixing schemes in modern history, with certain companies inflating prices by nearly 1,000%.”
Missouri and Kansas have joined 41 other states and Puerto Rico in a lawsuit accusing generic drug makers of conspiring to manipulate and drive up prices for more than 100 generic drugs, reports KCUR. The lawsuit, filed in federal court in Connecticut, alleges that generic drug giant Teva Pharmaceuticals significantly raised prices on more than 100 generic drugs beginning in July 2013 and colluded with competing companies to carve up markets and raise prices on at least 86 of those drugs. Missouri’s Attorney General called the alleged conspiracy “one of the most damaging and far-reaching price fixing schemes in modern history, with certain companies inflating prices by nearly 1,000%.”
Six Minnesota diabetes activists traveled to Canada to purchase $1,265 worth of insulin that would have cost them $12,400 in the U.S. According to the Star Tribune, insulin prices in the U.S. doubled between 2012 and 2016, with cases of insulin rationing becoming more common. The high price of insulin reflects many factors, including patent protections that keep competitors out of the market.
Montana’s Governor has signed a package of healthcare bills, including the reauthorization of Medicaid expansion and a program to lower insurance premiums on the individual market. Other legislation was aimed at lowering prescription drug prices and increasing access to medical, mental health and substance use treatment in rural and American Indian communities, according to the Governor’s Office. Other legislation would protect federally qualified health centers from discrimination in prescription drug pricing, hold accountable pharmacy benefit managers by applying protections to their billing practices and preventing surprise fees, and prohibit pharmacy benefit managers from requiring pharmacies to charge consumers more in copayments than it costs to make a drug.
Delaware state legislature easily passed a measure to establish the Interagency Pharmaceuticals Purchasing Study Group, according to the National Academy for State Health Policy. The group is tasked with an ambitious agenda, expected to submit recommendations to leverage bulk purchasing of pharmaceuticals to meaningfully lower drug prices by the end of 2019. The strategies to leverage the state’s combined purchasing power will hopefully help bring down the cost of health care in the state, where health care spending traditionally grows faster than the state’s economic growth and currently exceeds the national average.
Governor Gavin Newsom announced that Los Angeles county, one of the largest public purchasers of prescription drugs in California, will partner with the state to use their combined market power in an attempt to lower the cost of prescription drugs, reports The State Network. This announcement follows an executive order the governor signed directing California agencies to consolidate pharmacy purchasing authorities. The state Legislative Analyst’s Office reported that the Medi-Cal component of the executive order could potentially save the state hundreds of millions of dollars annually by increasing Medi-Cal’s bargaining power.
The Maryland General Assembly passed a slate of related measures to make health coverage easier to secure for uninsured Marylanders and prescription drugs cheaper for government workers, reports The Baltimore Sun. One law would require uninsured people to check a box on their state tax returns to report whether they’re interested in obtaining health coverage through the state. Another would establish a board to study the controversial idea of capping prescription costs for state and municipal employees. The legislature also enacted a patient’s bill of rights and approved sustained funding for a reinsurance program that helps insurers offset costs for the biggest healthcare users. Collectively, these measures are expected to make a significantly improve healthcare access and affordability for consumers.
A survey conducted by the Healthcare Value Hub found that one in two Pennsylvania adults struggled to afford healthcare, according to the Philadelphia Inquirer. Alarmingly, Pennsylvanians are coping with their affordability burdens by making decisions that may jeopardize their health such as: delaying care, avoiding getting care, skipping a test or treatment, failing to fill prescriptions or skipping doses. Pennsylvania adults pointed to, in particular, the rising cost of prescription drugs as a “major reason” for high healthcare costs. This is supported by other data that show that prescription drugs are one of the key drivers of high healthcare costs in the U.S. Other data show that certain populations – including medically vulnerable and older Pennsylvanians – are particularly hard hit by soaring drug prices. The survey revealed that there is support across party lines for government actions to curtail unfair prescription drug pricing and unreasonable price hikes.
A new survey conducted by the Healthcare Value Hub discovered that more than half (58%) of Coloradans were burdened by healthcare costs, according to the Durango Herald. Healthcare continues to be an important topic of conversation for Coloradans, especially those outside the Denver metro area, where nearly two-thirds of those surveyed indicated they were burdened by these high healthcare costs. The survey found that the majority of Coloradans (82%) agreed that the healthcare system needed to change to better meet the needs of the consumers. Coloradans should not have to delay or forgo healthcare due to cost: more than 40 percent delayed going to a doctor or having a procedure done, 38 percent avoided going altogether, 21 percent did not fill a prescription and 19 percent cut pills in half or skipped doses to save money.
Colorado is joining a growing number of states that wants to cut certain prescription drug prices by importing licensed drugs from Canada, according to the Highlands Ranch Herald. This idea is central to Governor Polis' campaign to rein in healthcare costs for Coloradans, many of whom (especially those in rural and mountain regions) pay some of the nation's highest insurance premiums. The Colorado Senate Health & Human Services Committee advanced a bill that would direct the Department of Health Care Policy and Financing to design a program in which the state takes on the responsibility to act as a wholesale importer of prescription drugs from licensed Canadian suppliers and distribute them to Colorado pharmacies and hospitals. Opposition to this proposal includes the Colorado Competitive Council and Colorado Chamber of Commerce, citing a lack of safety for patients to use drugs without FDA scrutiny.
California’s Governor announced several actions he would take related to healthcare, according to State of Reform. Governor Newsom signed an executive order placing all Medi-Cal prescription drug pricing negotiations under the Department of Health Care Services, rather than a “fragmented” array of purchasers. The Governor also wrote a letter to Congress and the White House asking lawmakers to “amend federal law” so that states can get waivers that allow for state-based innovation – “including creating paths to single-payer” – and provided a preview of healthcare-related items in his budget.
California released a pair of reports detailing spending on medicines, the costliest drugs and the treatments most frequently prescribed, reflecting requirements in a state law to increase transparency on prescription drug pricing, reports STAT. The reports contribute to an ongoing battle between state lawmakers and the pharmaceutical industry over the rising cost of medicines.
The Oregon Health Authority is moving to expand treatment for hepatitis C, a disease that affects nearly 30,000 of the state’s Medicaid beneficiaries, to everyone on the Oregon Health Plan who’s infected, according to The Lund Report. In 2017, Oregon’s Medicaid program spent $45 million, about 7 percent of the total prescription budget, on hepatitis C drugs. The Governor has requested $107 million from the health authority in her budget proposal, one which the Authority plans to approve. Experts hope that treating hepatitis C will save Oregon the cost of treating people with severe complications while stemming the spread of the virus.
Michigan has secured federal approval to negotiate Medicaid drug prices based on how well the medications work. This will give the state the authority to use additional rebate agreements for “outcomes-based” contracts with manufacturers, according to Modern Healthcare. This change comes after a congressional advisory panel on Medicaid found that drug spending increases have been higher for Medicaid than for other payers. Though it is too early to forecast savings, Oklahoma, which is using a similar amendment, has entered into alternative payment contracts for two drugs.
In 2014, Colorado Center on Law and Policy (CCLP) joined with consumer groups to address the high cost of specialty drugs in Colorado to open a dialogue with the state's Division of Insurance (DOI) and health insurers to address the unmanageable out-of-pocket costs, according to Health Affairs. Many plans charged coinsurance of up to 50 percent of the cost of drugs of the highest tier is discriminatory against people with disabilities and chronic conditions, in violation of the Affordable Care Act. Colorado's DOI enacted a regulation effective June 1, 2018, prohibiting plans from putting more than Most recently, Colorado’s DOI took decisive action by promulgating a regulation, effective June 1, 2018, prohibiting plans from putting more than half of drugs for a particular condition on the highest cost tier. Though it is difficult to assess whether enforcement of the rule will affect premiums, increases for 2019 individual plans are modest—an average of just 5.6 percent. Plan specifics for 2019 plans are now publicly available, and a review of formulary tiering for HIV drugs reveals some significant improvements from 2018. If carriers do not comply with the regulations of the ACA, the DOI should exercise its authority to assure that Coloradans have full access to the health care benefits and services they need.
The Minnesota Attorney General Lori Swanson targeted drug manufacturers in a lawsuit for inflating the cost of insulin medication, according to the Star Tribune. Swanson is accusing others of being complicit in price-gauging sick patients with diabetes as well as the drug manufacturers. The lawsuit named three drug companies, Sanofi-Aventis, Novo Nordisk and Eli Lilly, that have tripled the list prices of their synthetic insulin medication since 2002. These medications are crucial to people with diabetes to manage their blood sugar and reduce their risk of disability, even death. Swanson is saying part of the price hike is due to the rebate structure implemented by pharmacy benefit managers (PBMs) who have ignored the impact of these rising costs have on patients. PBMs currently play a role in deciding which drugs are listed on insurance companies' preferred list. Because the PBM profits come through rebates, manufacturers have incentives to curry favor with them by raising prices and inflating rebates. Rising prices of insulin have raised concern over the past year with everyone from the President to Senator Amy Klobuchar appealing directly to insulin manufacturers, demanding legislation to compel the companies to lower their prices. Minnesota is the first state to bring a case against the insulin manufacturers.
Michigan has asked CMS for permission to enter into outcomes-based contracts with drug manufacturers under its Medicaid program in order to make drugs more accessible for beneficiaries, according to Inside Health Policy. Outcomes-based contracts stipulate that if patients using the medications do not meet specified benchmarks, manufacturers could be on the hook for paying additional rebates. Proponents are optimistic that outcomes-based contracts can give Medicaid beneficiaries access to higher-cost medications more quickly, and that risk would be transferred to manufacturers. However, a study published by the Commonwealth Fund found that outcomes-based contracts have a limited capacity to reduce costs because they only apply to a small subset of medications. If the request is approved, Michigan would be the second state allowed to enter into outcomes-based contracts, behind Oklahoma.
Arkansas, like many states, is targeting drug middlemen in attempt to reign in high pharmaceutical prices, according to the Washington Examiner. The state enacted a law earlier this year requiring licensure for pharmacy benefit managers (PBMs), which manage drug plans for employer- and union-sponsored health plans, to conduct business in the state. PBMs must provide a “fair and reasonable” compensation program for the reimbursement of pharmacist services in order to get a license. Four other states have passed similar laws requiring PBMs to obtain licenses: Florida, Louisiana, Maryland and Tennessee.
Oklahoma's Medicaid program is implementing a first-in-the-nation drug pricing policy where the state only compensates drug companies the full price for their medications if they work as advertised, according to Business Insider. While the program is designed to hold pharmaceutical companies accountable for the efficacy and safety of their drugs, participation is voluntary—potentially mitigating the desired effect. But drug companies that do sign up will have their effective products included in a “preferred drug list,” which could result in a greater long-term profits.
Ohio is fighting to release a report detailing what it paid to two PBMs, CVS Health and Optum, to manage its Medicaid program’s prescription drug plans. According to NPR, the report shows that the companies charged the state 8.8 percent more than they paid to pharmacies to fill prescriptions. The companies kept the more than $224 million difference between what they charged the state and paid for the drugs. Ohio's Medicaid program is run almost completely through private managed care insurance companies, who contract with CVS Health and Optum to manage the prescription drug portion of recipients’ coverage. CVS Health representatives have argued that the company saved the state $145 million compared to an alternative and releasing the report would harm the company’s ability to negotiate low prices.
Louisiana is evaluating a subscription-based payment model for high-cost drugs targeting Hepatitis C, according to the state’s Department of Health. The cost of Hepatitis C treatment, which affects 30,000 people in the Louisiana Medicaid program and prison system, creates barriers for the most vulnerable populations suffering from the disease. Under this payment model, the state would pay a drug manufacturer or manufacturers for unlimited access to the treatment for the individuals in Louisiana who are enrolled in Medicaid or in Louisiana’s correctional system. The total payment to the manufacturer would be equal to or less than what the state is currently spending, but by paying less per person, would reach many more patients.
Ohio Attorney General Mike DeWine is ramping up his investigation into the costly practices of pharmacy middlemen, hiring outside counsel to assist with a probe he expects to lead to litigation against companies managing drug benefits for Medicaid and other tax-funded health insurance programs. According to The Columbus Dispatch, DeWine stated that “today, I am putting PBMs [pharmacy benefit managers] on notice that their conduct is being heavily scrutinized, and any action that can be taken and proven in court will be filed to protect Ohio taxpayers and the millions of Ohioans who rely on the pharmacy benefits provided.” The announcement was applauded by the Ohio Pharmacists Association but criticized by political opponents who characterized the move as an empty gesture designed to shore up votes before the election.
Supporters of California’s recently enacted drug pricing transparency law (SB 17) are calling it a success after several manufactures notified California health plans that they are rescinding previously announced price increases, according to State of Reform. The law requires drug manufacturers to notify purchasers at least 60 days in advance if they plan to increase a drug price by more than 16 percent in a two-year period. To date, prescription drug price transparency laws have been enacted in Oregon and Vermont and are pending in several other states. Despite supporters’ claims of success, it remains to be seen if transparency reporting requirements will have a long-term effect on rising drug prices.
Portland nonprofit Project Access Now, working with charitable funding from the metro area’s nonprofit hospital systems, has expanded its program offering free or heavily discounted generic drugs to working-class people with high-deductible health plans. According to The Lund Report, program participants pay either $4 per prescription or get their medications at no cost. Linda Nilsen, the executive director of Project Access Now, stated that, “pharmaceutical access is key to assuring improved health outcomes -- the remaining uninsured and underinsured still face significant barriers to getting the medications they need.” She believes that access to pharmaceuticals is key to improving health outcomes.
New data from Ohio's Quantum Health reveals that its Precision Specialty Pharmacy Management program reduced cost by 55 percent, or an average of over $80,000 per case annually, for members transitioning from insurance carriers to the company's consumer healthcare navigation model. According to Markets Insider, Chief Medical Officer Dr. Dana Andrews attributes the results to the company's active collaboration with the members and their providers to identify those who could receive the medication in a more cost-effective site of care. Currently in the U.S., the 1 to 2 percent of people who take specialty medications drive nearly 40 percent of all drug spending.
Recent legislation in Maine directs the Maine Health Data Organization to report on the 25 most commonly prescribed drugs that have experienced large cost hikes, according to NASHP. The Maine Health Data Organization must establish a plan for data collection from manufacturers, and provide Maine lawmakers with an annual report on prescription drug prices beginning in April 2019.
Two new Louisiana laws aim to regulate drug pricing and providing more transparency in how prices are set. According to NOLA.com, the legislation (SB 282 and SB 283), requires pharmaceutical benefit managers (PBMs) to share more information about how they operate in Louisiana. PBMs negotiate rebates from drug makers to insurers in exchange for lower co-pays, but often do not pass rebates on to the consumer. A recent Altarum study estimated that health insurers nationwide received an estimated $86 billion in rebates in 2016 alone. PBMs will now be required to release an annual report that discloses the percentage of any rebates received from drug manufacturers. Additionally, insurers will have to let enrollees know when they are being charged more for a prescription drug than the insurer itself pays.
Vermont is the first state in the nation to approve importation of less-costly prescription drugs from Canada, according to NASHP. The new law creates a wholesale importation program to purchase high cost drugs through authorized wholesalers, who will purchase the drugs in Canada and make them available to consumers through an existing supply chain that includes local pharmacies. The law requires the Vermont's Agency for Human Services to work with stakeholders and the federal government to design and submit an importation proposal to the state legislature by Jan. 1, 2019. The agency must also submit its proposal to the federal government for final approval by July 1, 2019. The program must be operational within six months of approval of the financing strategy, certification and federal government sign-off.
A new Connecticut law requires drug companies, health insurers and pharmacy benefit managers to disclose a wide range of drug pricing information to the state, reports CT Mirror. Key provisions that go into effect on Jan. 1, 2020, include: requiring drug companies to justify potentially unwarranted drug price increases over specified periods of time; requiring insurers to identify the 25 drugs with the highest cost to the plan, the 25 with the greatest year-over-year price increases and the 25 most frequently prescribed, as well as the premium growth that is attributable to prescription drugs; and requiring PBMs to report how much they collect in rebates and the share that they keep. Insurers will also be required to report whether they use the rebates to offset premiums or pass the money down to residents at the pharmacy counter. The bill does not include a previous requirement that the majority of rebates from drug companies be passed down to consumers when they buy drugs at pharmacies.
A new Arizona law prohibits pharmacy benefit managers (PBMs) from restricting pharmacists from providing information regarding the amount of patients’ cost share and the clinical efficacy of available alternatives, reports the Alliance for Transparent & Affordable Prescriptions. The law also prohibits PBMs from requiring pharmacies to charge or collect copayments that exceed the cost of the drug. Arizona is one of a slew of states that have recently passed similar legislation.
New Hampshire is one of several states that has proposed legislation to outlaw “gag clauses” that prevent pharmacists from telling consumers when there are cheaper drug alternatives available and provide more disclosure about the business relationship between pharmacy benefit managers, health plans and pharmacies, according to the National Academy for State Health Policy. This gag clause type of legislation is gaining momentum in several states in the 2018 legislative year.
Intermountain Healthcare together with four other partners will form a nonprofit company that will supply about 20 generic drugs to their hospitals, according to a news story in The Salt Lake Tribune. The goal is to prevent price-gouging from certain pharmaceutical companies and deal with drug shortage issues.
Legislation proposed in Utah would provide for a wholesale importation program with Canada for higher-cost drugs, according to NASHP. The program would become the first in the nation to import drugs that are already licensed for sale in Canada where high cost drugs can be 30 percent less than in the United States. The legislation promises to generate significant cost savings for the state of Utah and its residents.
Maryland wants to eliminate a “gag rule” that prevents pharmacists from telling consumers that they can pay less for their prescription drugs, joining a nationwide movement to rein in soaring costs, according to the Washington Examiner. If Maryland succeeds, it would mean that pharmacies would be allowed to inform customers they can pay less for a drug out of pocket than through their insurance. Maryland would join five other states—Connecticut, Maine, Louisiana, North Dakota, and Georgia—that have banned the "gag rule" that some pharmacy benefit managers put in their contracts with pharmacies.
According to an article in Dallas News, Texas legislators are entitled to details about how pharmaceutical giant Pfizer priced drugs offered through the state's expansive Medicaid program after a judge’s ruling. State lawmakers have been seeking methods to offset soaring costs and generate hundreds of millions in savings from Medicaid programs.
According to The Lund Report, Rep. Rob Nosse plans to introduce legislation that will require pharmaceutical companies to provide state regulators with detailed explanations of price hikes and their products’ effects on healthcare costs, mirroring a California state law enacted earlier this month.
Governor Jerry Brown signed California's AB-265, which will limit the use of copay coupons and other discounting strategies for branded prescription drugs when a cheaper generic is available, reports FiercePharma. Brown authorized the bill on the same day he signed SB-17, a separate piece of legislation which will force drugmakers to give warning of and explain price hikes. Together, the bills represent two significant regulatory steps on drug pricing in a critical state. Other states could follow the model as many around the country look to take pharmaceutical prices into their own hands.
The California Governor signed a sweeping drug price transparency bill to force drugmakers to publicly justify big price hikes, according to Kaiser Health News. The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16 percent or more over two years on drugs with a wholesale cost of $40 or higher. They must also explain why the price increases are necessary. The bill drew support from a diverse coalition, including labor and consumer groups, the hospital industry and even health insurers. But some experts say that transparency alone is not enough to bring down drug prices, and that California’s law may lack the muscle being applied in other states to directly hold drug prices down.
According to Policy and Medicine, in mid-June 2017 Governor John Bel Edwards of Louisiana signed two drug price transparency measures. HB 436 requires manufacturers engaging in the marketing of prescription drugs in the state to make quarterly reports of the wholesale acquisition cost (WAC) prices to the Louisiana Board of Pharmacy, while SB 59 requires the Louisiana Board of Pharmacy to post on a website those WAC prices, organized by therapeutic category.
Last year, Vermont passed Act 165, the nation’s first drug price transparency law, which has spawned similar legislation across the country, according to NASHP. Act 165 requires the Green Mountain Care Board to identify “drugs on which the state spends significant health care dollars and for which the wholesale acquisition price has increased by 50 percent or more over the past five years or by 15 percent or more over the past 12 months.” The board reports to the state’s Attorney General (AG), who may require manufacturers to submit information and documentation justifying the price. In assessing the impact of the legislation, observers have noted that the law addresses only Medicaid expenditures and does not affect other large purchasers. Also, manufacturer data the law required was not highly detailed, which has made it difficult to gauge if the prices and increases are justified or not.
A new Connecticut law will outlaw “gag clauses” in pharmacy benefit-manager contracts that now bar pharmacists from telling consumers when they could save money by paying out of pocket for generic drugs that can cost less than the co-pay for a covered brand-name drug, according to the Connecticut Mirror. The bill also would require insurers to give better notice to consumers regarding the cost of using out-of-network labs.
Drug companies asked a federal judge to throw out Maryland's new prescription drug price gouging law, saying the state's first-in-the-nation measure is both unconstitutional and vague. The law, which takes effect in October, allows the state’s Attorney General to prosecute some manufacturers that impose "unconscionable" price hikes, according to the Baltimore Sun. Passed by the General Assembly with near unanimous support earlier this year, the law only governs off-patent and generic drugs, not branded medications protected by patent laws.
Beginning July 1, MORx – a program that helps Missouri seniors afford prescription drug costs – will cease coverage for over 60,000 individuals, increasing the amount they will have to pay for prescription medications, reports The Rolla Daily News. While the change will not affect “dual-eligibles” enrolled in both Medicare and Medicaid, others will be forced to make difficult trade-offs that potentially put their health at risk.
Nevada’s Governor signed into law the nation's strictest requirements for pharmaceutical companies to reveal how they set certain prescription drug prices, according to CBS MoneyWatch. The law requires drug makers to annually disclose the list prices they set, profits they make and discounts they give to market middlemen on insulin and other diabetes drugs sold at prices that have skyrocketed during the last decade.
Public outcry over high-priced Hepatitis C drugs has prompted Louisiana officials to propose using an obscure federal law to get medicines at a lower cost, according to Kaiser Health News. Hepatitis C treatment in Louisiana would cost the state a staggering $764 million for the 35,000 uninsured and Medicaid enrollees with Hepatitis C. Under existing federal law, the Trump administration could sidestep patents and contract with a generic supplier to offer a lower-priced version of the expensive antiviral drugs. The government would have to pay the drugmaker only “reasonable compensation” and prove that using the product benefits the U.S. government.
A bill allowing Maryland’s Medicaid administrator to inform the attorney general’s office when it sees patients being charged higher rates for drugs has passed the General Assembly, according to the Baltimore Sun. Advocates hope that the bill will have a ripple effect and move other state legislatures to pass similar laws.
Corrections officials told lawmakers that medical costs are rising fast within the system, driven by a combination of factors the department isn't in control of, according to the Nevada Appeal. The inmate population is aging, causing them to require more trips to the hospital and longer stays. He said there are new drugs available that do much better at controlling chronic diseases but those drugs cost more, such as new drugs to treat hepatitis C.
New data from the New Hampshire insurance department show that prescription drug costs are rising faster than most other categories of health spending in the state, according to New Hampshire Public Radio. Pharmacies collected one in five dollars spent on healthcare in New Hampshire last year. Still, the report noted that despite their increasing price tags, high-cost drugs comprise less than 1 percent of all prescriptions for people with employer-based insurance and other group plans.
The Texas Health and Human Services Commission is being sued after providing drug pricing data to two Texas Senate committee heads, according to Modern Healthcare. The Texas Attorney General claims the disclosure was required under Texas law, yet Pfizer insists the action violated federal law.
Hepatitis C is the most expensive condition treated in Medicaid, due to blockbuster drug prices, according to the Albuquerque Journal. New Mexico’s total spending for prescription drugs has risen by 54 percent in two years, with Hepatitis C drugs accounting for nearly two-thirds of the 2016 pharmaceutical drug expenses. Last year the New Mexico Department of Human Services developed a hepatitis C action plan with the goal of treating all Medicaid patients with hepatitis C within a decade while being financially responsible.
In light of the recent price increases for Epi-Pen, the Maryland Citizens’ Health Initiative is pushing Maryland lawmakers to addressing the rising cost of drugs. According to the Washington Post, the group wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the attorney general authority to take legal action. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
A Maryland-based healthcare advocacy group is pushing Maryland lawmakers to address the rising cost of drugs, according to The Washington Post. The Maryland Citizens’ Health Initiative wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the Attorney General the authority to take legal action against price gouging. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
After being approved by a key committee, a bill that would have required drug companies to justify treatment costs and price hikes was pulled by its author, according to Kaiser Health News. California state Sen. Ed Hernandez (D-West Covina) said that he introduced the bill “with the intention of shedding light on the reasons precipitating skyrocketing drug prices.” But subsequent amendments by an Assembly committee made it difficult to accomplish this goal, he said in a statement.
The lead sponsor of a Massachusetts bill calling for some of the nation’s most sweeping steps to control prescription drug costs scrapped a controversial provision that would have capped prices on treatments for critical illnesses such as hepatitis C, according to the Boston Globe. “It’s nearly impossible for policy makers, regulators and regular consumers to know the true markup on drug prices,” the Hub’s Lynn Quincy said, suggesting the factors that go into calculating drug prices have long been “shrouded in secrecy” in the United States.