There is no shortage of good intentions and even better ideas on how to bring sanity to the overwhelming complexity of rising drug prices — and doing so without blocking the pipeline of life-saving new drugs.
None of those ideas, however worthy, are likely to make any headway in gridlocked Washington today. So it rests with the states to fix that which can be fixed.
“The rapidly rising costs of prescription drugs is the single greatest issue facing individuals and families,” said Senate President Karen Spilka. “For far too many, it is a crisis.” And heading the list of life-saving drugs the Senate bill zeroes in on is one that is nearly a century old — and yet has seen its price more than triple in just the past decade.
“The stories of insulin rationing and other desperate acts are simply unacceptable,” Spilka added at a press conference introducing the legislation.
With tales of trips to Canada — where a 10-day supply of the diabetes drug costs about $30 compared with $300 in the United States — becoming more common and some patients resorting to home-brew insulin, the legislation proposes to make insulin its first pilot program for cost containment.
After all, diabetes affects 1 in every 10 Massachusetts residents. And Colorado and Minnesota have already embarked on programs to at least bring the cost of this one high-impact drug to heel. Colorado set a $100 a month cap per patient on the cost of insulin. The Massachusetts Senate bill proposes to eliminate insurance plan deductibles and coinsurance and cap co-pays on the drug at $25 a month.
The figure is not unrealistic. Earlier this year insurance giant Cigna and its pharmacy benefit arm, Express Scripts, announced their plan to cap the 30-day cost of insulin at $25. That’s a far cry from the $1,000 a month in out-of-pocket costs the Senate’s Health Care Financing Committee has documented for those in high deductible plans or among the under-insured.
The Senate bill is, of course, far more wide-ranging and complex than just that one pilot program. It also seeks to build on the new powers recently given to the Health Policy Commission to negotiate the price of the highest-cost drugs paid for by taxpayers under the Medicaid program. The Baker administration is already claiming savings of $6 million following negotiations with three companies over six drugs. Some 80 more drugs are on their negotiating list.
The legislation seeks to broaden the powers of the commission to look at any drugs costing $50,000 a year or more or any “drug whose cost exceeds an HPC value for that drug.”
“You will see a public process around cost and proposed value,” said Senator Cindy Friedman, cochair of the Health Care Financing Committee.
The bill additionally proposes to license pharmacy benefit managers — those middlemen in the pharmaceutical world — and requires pharmacies to provide information to consumers so that they can access drugs at the lowest possible cost.
There are some similarities to the drug sections of Governor Charlie Baker’s wide-ranging health care bill filed last month. And there are differences in approach. But frankly, only on Beacon Hill will that matter. What matters on Main Street is that no one should have to cross our northern border to buy life-saving drugs. That no one should try to whip up a batch of insulin in the basement. That consumers know that the drugs they and their insurers are paying for will be assessed for both cost and value.
Bending the drug cost curve will never be easy. But taxpayers and consumers demand their elected officials at least try.