What Can Connecticut Do About High Drug Prices?

By Jill Zorn |

Medicine and money

Drug prices keep going higher and patients are paying more and more.

What can Connecticut do about skyrocketing drug prices and unaffordable out-of-pocket costs?  Connecticut’s Health Care Cabinet has devoted a lot of time and effort this year to trying to find some answers. 

On Tuesday, the Cabinet heard draft recommendations from three work groups.  A long list of ideas is coming together.  Here are some highlights:

  • Set monthly co-pay and co-insurance limits to protect patients from coming up with the full cost of their expensive medications in the beginning of the year
  • Require that patients are paying out-of-pocket based on the discounted price their insurer has negotiated, rather than the list price
  • Consider forming a state Drug Review Board to analyze and determine whether certain drug prices and price increases are not justified
  • Enhance the authority of Connecticut’s Attorney General to pursue price gouging cases against manufacturers of both generic and brand name drugs, when the Drug Review Board has found that those price increases are not justified
  • Have the Insurance Department collect information on the cost of prescription drugs and their impact on insurance premiums when insurance companies submit their rate requests
  • Identify ways that Medicaid and the State Employee Health Plan can continue to save on prescription drug costs as well as avoid health care costs that result from patients not taking their medications as directed

To see the entire list, go HERE and review the work group documents and summary presentation from the December 12 Cabinet meeting.

The Stakeholders are Watching

How will these recommendations be received by the many organizations involved with prescribing, delivering, manufacturing, selling or buying prescription drugs?

The list of stakeholders is a long one.  Obviously, physicians and other prescribers, hospitals and pharmacies are integrally involved.  Then there are the payers: insurers or self-insured employers that pay pharmacy claims and design benefits packages that have an impact on access and use of medications.

Finally, there are these key corporate players:

  • Brand name pharmaceutical manufactures: They discover the medicines, test them and bring them to market.
  • Generic drug manufacturers: They develop and sell medications after they go off patent.
  • Pharmacy Benefit Managers (PBMs): These entities are often hired by payers to bargain on their behalf with pharmaceutical manufacturers to get better prices on prescription drugs.  This relatively unknown but highly consolidated and powerful industry has been increasingly identified as a possible contributor to the cost problem, too.

At one level, all of these stakeholders care about patients’ and employees’ health.  But at another level, they are all in business to make money.  And if one industry prospers, it can sometimes be at another’s expense.  It is quite common to find one of these stakeholders discussing the problem of high drug costs, accuse another of being the cause, and never quite get around to admitting that they, too, may be part of the problem.

Industry stakeholders are watching the Healthcare Cabinet process closely.  Lobbies for both the pharmaceutical industry and the health insurance industry have already submitted letters commenting on them.  Go HERE, to the December 12 cabinet meeting to see comments from the Connecticut Association of Health Plans (CTAHP) and a comment letter submitted by the Pharmaceutical Research and Manufacturers of America (PhRMA).

What About the Patients?

Where are the consumers?  The patients? We are at the end of the line, after everyone else has been paid.  Too many of us are skipping doses, cutting pills in half or failing to fill our prescriptions because we can’t afford them.

The Cabinet recommendations are a work-in-progress.  With industry lobbyists already weighing in, it will be extremely important for Cabinet members to hear from every-day people.

The next Cabinet meeting will be devoted to hearing from the public.  The meeting is scheduled for Tuesday January 9 at 9 am at the State Capitol, Room 310.  Information will be available soon for how to submit written comments.


Resources

Go HERE for materials from the Healthcare Cabinet’s December 12 meeting.  The cabinet plans to pull one summary document together soon.  But in the meantime, there is a PowerPoint presentation summarizing the recommendations of each work group, as well as more detailed documents from each group.

CT-N recorded the meeting.  Right now, and for approximately the next week it is available on demand HERE.  The Healthcare Advocate’s comments near the end of the meeting, just before the 1 hour 58 minute mark.

Kaiser Health News published an article this week on the odds that Congress will make much headway on drug pricing in the near future.  The short answer is “NO”, which is why states are stepping up to the plate.  Go HERE to read the article.

The Kaiser article refers to a newly released report from the National Academies of Sciences Engineering and Medicine, Making Medicines Affordable:  A National Imperative.  Go HERE and HERE to learn more about the report.

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