By Jill Zorn |
The Healthcare Cabinet has written a draft report on how Connecticut can address high prescription drug prices and they are seeking public comment on their recommendations. Go HERE (scroll to the bottom of the page) to find a copy of the report.
You can be sure that lobbyists for pharmaceutical corporations, pharmacy benefit managers (PBMs) and insurers will be commenting. That is why it is important for the voices of every-day people to be heard. We also encourage non-profit organizations to weigh in on behalf of the people they serve and clinicians to comment on behalf of their patients.
This blog highlights several key recommendations, those that focus on price transparency and regulatory action against unjustified high prices, as well as two ideas for protecting consumers from unaffordable out-of-pocket costs. The blog closes with information about how to comment on the Cabinet recommendations either in writing, in-person at the Cabinet meeting or both.
Summary of Key Cabinet Recommendations
The Cabinet report is 24 pages and is written in fairly technical language. Priority recommendations start on page 7, following an overview of legislation that has passed in other states. Other recommendations start on page 13. In its current draft form, the report has no executive summary.
Identifying Unfair Prices and Referring Cases to the Attorney General for Action
This top recommendation in the report (1.a.,pages 7-8), essentially has two parts:
- Form a state Drug Review Board to analyze information and determine whether certain prescription drug prices and price increases are justified. Some of the information the Board will analyze will initially be collected by the Insurance Department during their rate review process, including information about the extent of recent price increases and their impact on premiums (see 2.a., pages 11-12). Some of this information will become public. But proprietary information providing more in-depth justification of price increases will remain confidential.
- When the Board finds examples of unjustified price increases they will make referrals to the Attorney General. The Attorney General will have enhanced authority to pursue price gouging cases against manufacturers of both generic and brand name drugs.
The recommendation is based on bills that have passed in other states, particularly California, Maryland and New York. One challenge, however, is that the pharmaceutical industry has challenged the California and Maryland laws in court. But advocates are optimistic that these laws will prevail.
It is also important to note that this is a high-level recommendation and more details are needed if this recommendation moves on to legislative action. For example, the size and composition of the Drug Review Board, including how many consumers will sit on the Board, has not been decided. Who will make appointments and where the Board will fit in the current administrative structure, is also not spelled out. And the cost of establishing and staffing the Board is not included. While the board will be composed of volunteers, there will likely be some cost associated with the providing staff support to this effort.
Out-of-Pocket Relief for Consumers
The first of these recommendations is identified as a priority and the second one is still in the list of “other” recommendations. But we think both are important.
- Require that patients pay out-of-pocket (co-insurance, deductibles) based on the discounted price the Pharmacy Benefit Manager (PBM) has negotiated on behalf of the insurer (recommendation 1.d., page 10).
As we wrote in a previous blog about the evolving Cabinet recommendations, PBMs are a highly consolidated and powerful industry. Drug corporations like to point the finger at PBMs as being part of the problem rather than part of the solution, for high drug prices.
Right now insurers funnel most of the savings that PBMs negotiate into reduced premiums. But that leaves patients paying full price at the pharmacy counter.
In other parts of the health care system, if your insurer has negotiated a discounted price, such as for hospital care or a radiology procedure, that lower price is what is charged if you must pay a percentage of the price (co-insurance) or must pay out of pocket if you haven’t fulfilled your deductible. This should be the case for prescription drug prices, too. But it isn’t. Right now patients are paying based on the list price, not the negotiated price, when they are paying out-of-pocket for their medications. And patients have no idea what the negotiated price IS.
Ironically, the pharmaceutical corporations may actually support this recommendation. But insurers and PBMs may be less happy with it. That is why it is important for people to speak up and demand relief from unaffordable out-of-pocket payments.
- 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 (3.e., page 15), until their out-of-pocket caps kick in.
This recommendation is based on a bill that was implemented in California in 2017 that set fairly high limits: $250 and $500 per prescription, depending on the type of plan you have. For high deductible health plans, the California law is less helpful as the cost sharing limits only kick in after the deductible is met. But the analysis conducted before the bill passed showed that these limits would be high enough that they would not raise premiums, while still being helpful to many consumers.
Public Comment Logistics
You can choose to comment in writing, in person, or both.
- Tell your story: Why is the issue of high prescription drug prices important to you? How is it affecting you, your family, friends, employer or co-workers?
- Emphasize that it is important for Connecticut to take action
- Highlight one or more of the priority recommendations
- Raise up any other recommendations you would like to see included in the final report or that you have concerns about
Written comments are due by 4:30 pm on Monday January 15 and can be emailed to this address:
Even if you are planning to comment in person, it is worth submitting comments in writing, since all comments will be posted on the Cabinet web site for both other members of the public and Cabinet members to read.
The Healthcare Cabinet is meeting on Tuesday January 16 at 9:00 am. All meetings open with an opportunity for public comment. A sign-up sheet is used to determine the order that people will speak, so you should plan on arriving earlier than 9 to sign up to comment. Commenters are limited to 3 minutes. This is an opportunity to tell your story briefly and then highlight one or two recommendations that you support.
The cabinet is meeting in the State Capitol, Room 310. You can park at the Legislative Office Building (LOB) and then take the concourse that runs from the Legislative Office Building to the Capitol. Please allow time to be screened when entering the LOB, as well as to walk to the Capitol.