Long after the current challenges of fighting a worldwide pandemic have eased, the day-to-day problem of making sure the state’s residents have access to life-saving drugs at an affordable price will still be part of the health care landscape.
The Massachusetts Senate made a third attempt this week to solve a piece of that puzzle, passing a bill that increases access to prescription drugs and adding some much-needed transparency and oversight to the pharmaceutical industry and to drug pricing. And wouldn’t it be a welcome change if this year the House, which for far too long has shied away from reforms, would welcome some of those proposed changes too.
Sure, the nation owes a huge debt to those researchers and drug companies that have in the past year brought life-saving vaccines and COVID-19 treatments to the market with record speed. But such gratitude must be balanced against the needs of a person with diabetes — and that’s 1 in 10 people in this state who have actually been diagnosed with the disease and for whom the rising cost of insulin is a matter of life and death.
And so the Senate PACT (Pharmaceutical Access, Cost and Transparency) Act goes directly at that issue, by capping co-pays for insulin at $25 per 30-day supply. At least 19 other states have already capped co-payments specifically for insulin.
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The bill would also assure consumers that the amount they pay for a drug — through a co-pay or deductible — never exceeds the retail price of that drug. And it would help ensure that patients can get their prescriptions filled at the pharmacy of their choice, one of several ways the bill seeks to boost independent pharmacies.
At its core, the legislation draws the connection between drug prices, transparency, and public health.
“High and rising costs of prescription drugs impede the ability of physicians to provide the best quality of medical care possible to patients” is the way the Massachusetts Medical Society put it in a recent policy statement. The society is a member of a state coalition of groups advocating for the Senate legislation. “The COVID-19 pandemic has made clearer the importance of access to affordable medications — from inhalers to insulin — to protect those with chronic conditions at highest risk for complications from the virus,” the statement said.
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In fact, the legislation would set up a trust fund to provide financial help to purchase prescription drugs for certain chronic conditions that disproportionately impact low-income communities and communities of color. Think asthma inhalers, for one obvious example. The trust fund would be the recipient of fines collected from drug manufacturers or pharmacy benefit managers found not in compliance with the oversight process.
And those new oversight processes include:
▪ Licensing by the state Division of Insurance of pharmacy benefit managers, the middlemen used by insurance companies to develop their drug formularies and to contract with drug manufacturers and pharmacies. The bill would impose sanctions on managers found not operating in “the best interests of consumers.”
▪ Requiring advance notification to the state by pharmaceutical companies about to bring new or biosimilar drugs to market or prior to significant increases in the prices of existing drugs.
▪ Empowering the Center for Health Information and Analysis to collect a wide range of drug cost information from pharmaceutical manufacturers — with protections for confidentiality — and from PBMs. It also adds drug costs to CHIA’s annual health care cost analysis.
▪ Empowering the Health Policy Commission — in consultation with stakeholders — to establish a process for determining drug price changes that “pose a public health threat.” The bill would essentially enable the HPC to treat drug costs in much the same way it treats cost growth in other sectors of health care — witness its recent report on Mass General Brigham.
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Massachusetts lawmakers have in the past been extremely deferential to the pharmaceutical industry generally and the biotech sector more specifically. The Massachusetts Biotechnology Council, the group’s chief lobbying organization, was headed by a former member of the House until last year. Today, its new CEO is former state senator Joe Boncore.
A Baker administration proposal for curbing rising drug prices paid through the state Medicaid program finally made it through in the summer of 2019 in a somewhat watered-down version — but not before the controversy held up the state budget of which it was part for several weeks.
The Senate passed a cost containment bill in 2017 and unanimously passed an earlier version of its access and transparency bill in November 2019. (Boncore was among those voting for it at the time.) That bill got a good leaving alone from the House and officially died with the end of the session in January 2021.
Now it’s back in a new and improved version — the insulin co-pay cap was only a pilot program in the 2019 bill. Massachusetts has been late to the drug transparency party and remains behind the standards set by states like California, Oregon, and Vermont. This is as good a time as any to make up that lost ground.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
