Panel to determine drug prices

Chris Garcia, a father of three and a community activist in Denver, lives in fear of minor accidents.

Garcia lives with four bleeding disorders, including hemophilia. Any injury can quickly lead to a health emergency.

Chris Garcia speaks during a virtual press conference on March 8, 2021. (Screenshot from John Ingold, Colorado Sun)

But it’s not just the physical risks that worry him. Garcia uses a drug called Humate-P to control its conditions. He said one bottle costs 10,000 dollars. He needs four vials every time he gets an injection, which means huge medical bills and financial disaster looming constantly. He said he worked multiple jobs to make sure he could afford his health coverage and medication.

Now, though, Democrats on the state Capitol believe they have come up with a solution that will help Garcia and other Coloradin residents: They want to create a state council that determines whether the drugs are affordable. And – here’s the biggest part – the board will have the authority to set the maximum prices that can be charged in Colorado for those drugs deemed unaffordable. No other country in the country currently has a board of directors that does this, despite the idea spreading across the country.

“Chloradane should not live in fear of their families’ financial ruin just because of our drug costs,” Garcia said last week during a virtual press conference hosted by the Colorado Consumer Health Initiative, an advocacy group that supports the legislation.

Suggest or offer – Senate Bill 175, Which will create something formally known as the Prescription Drug Affordability Review Board – the first panel hearing is scheduled for Wednesday afternoon. It is expected to receive strong opposition from the pharmaceutical industry, which has already launched an advertising campaign against it.

Government. Jared Polis delivers his state of the state speech to the House of Representatives at the Colorado Capitol on Wednesday, February 17, 2021.

Great healthcare fighting Capitol fermentation

The bill is just one of several that could serve as a transformative hearing on health care policy in Colorado, as Democrats, encouraged by a majority at the state headquarters and Democratic Control in Washington, D.C., are looking to use the full force of the state’s regulatory authority to grapple with healthcare costs or To improve the value of what people pay for.

There are proposals to claim insurance companies To cover an annual mental health exam Without discount, To expand the program To import prescribed medicines from other countries, and To tighten regulation On non-insurance coverage sharing programs.

The Medicines Affordability Bill gives the state attorney general the power to impose a $ 1,000 fine on an entity that violates the board’s payment ceiling for drugs. It gives the state commissioner of insurance the power to fine drug makers of up to $ 500,000 if they fail to provide adequate notice that they are withdrawing a drug from the market in Colorado after the board places a cap on its price.

The conflict over all of those bills is likely to pale in comparison to the measure surrounding the measure expected to be introduced later this week: a bill telling insurers to start offering more affordable coverage plans – or otherwise. If the companies fail to do so, the state will create its own insurance company, which will pay the government-dictated rates for healthcare that every doctor and hospital in the state must accept.

“We know, the Americans know, we’re sick and tired of being robbed in this,” Governor said. Jared Polis, speaking at last week’s press conference.

Prescription bottle next to the pills. (Photo by USDA via CreativeCommons)

Determine drug prices

Spending on prescription drugs has increased in Colorado in recent years, especially for people with private health insurance. Coloradans spent $ 6.7 billion on prescriptions in retail pharmacies in 2019, According to the non-partisan Caesar Family Foundation.

But there is still a lot of unclear why this spending has risen so much and where all the money and rebates that manufacturers pay are going. So the House created in Senate Bill 175 will first be assigned an investigative role: it will use the complex set of calculations set forth in the bill to determine whether a property should be considered unaffordable.

The assembly would consist of five members, all appointed by the governor and subject to confirmation by the state senate. Persons who work for pharmaceutical companies, insurance companies, or pharmacy benefit management companies – or any of their trade associations – are specifically prohibited from serving.

For drugs that you consider unaffordable, the board can then set a “threshold for the payment”. It is unclear exactly how the board can do this. Board members will have to set their own rules.

The price cap will apply to “all purchases and payments of dues for a prescription drug dispensed or given to individuals in the state.” In other words, insurers will be barred from paying more for the drug the board allows – or requiring their members to pay more for the drug through deductions.

While other states have established or are considering establishing affordability review boards for prescription drugs, none of those other states yet have had a board setting price limits as to whether or not the limits can be legally challenged. There is no federal entity that regulates drug prices widely.

Truvada for PrEP, an anti-retroviral drug for HIV that is taken by people without HIV in high-risk communities. (Tony Webser, via Creative Commons)

The industry is raising concerns

The pharmaceutical industry argues that these price caps will result in consumers having fewer options for the drugs they can get.

“Creating a council of unelected bureaucrats with the authority to make arbitrary decisions about drugs of value and drugs that patients can receive would be a disaster for patients,” said the commercial group PhRMA, which represents makers of brand-name drugs, in a statement. “… in practice, this policy can make it difficult for individuals to access the drugs they need now and in the future and can lead to discrimination against the elderly, the disabled and the chronic.”

Proponents of the bill say it has the potential to save up to 75% of the drugs it cannot afford. The bill would require insurers to pass savings from price limits onto consumers, although industry representatives such as PhRMA question whether the state will actually be able to achieve this.

State Senator Sonia Jacques Lewis, a Boulder County Democrat and a sponsor of the bill, likened the price limits to what was created in the Colorado insulin price cap for the first time in the country – despite that cap. It had its own flaws.

“It’s the same,” she said. “It’s basically saying we have to make prescription drugs accessible to everyone, and that’s one way to do that.”

She and other supporters said the bill could reduce public spending on healthcare in another way – by allowing people to bear the costs of their medications so that they can take them when needed. One in 10 Colorado residents skipped needed medication doses in 2019 due to concerns about cost, according to a nonpartisan Colorado Health Institute survey.

“I’ve seen the costs of prescription drugs keep going up,” said Jacques Lewis, a pharmacist who previously worked for Medicaid in Colorado. “This is really forcing the Coloradans to make impossible choices.”


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