Prescription drug costs, which have risen substantially in recent years, now account for a fifth of all health care spending. As a result, a quarter of Americans say they have a difficult time paying for their prescription medications and nearly one in 10 say they do not take their medication as prescribed to save money.
This is not sustainable. There are efforts in Congress and the Maine Legislature to slow the cost increases to ensure that people don’t go without needed medication.
Although rising drug costs have been a problem for years, action is slow at the federal level. That leaves it to states to find ways to lower drug prices for their residents. This is not as effective as a comprehensive national approach, but state action could propel movement on federal fixes.
Maine lawmakers are considered a package of bills aimed at lowering prescription drug prices. The Legislature’s Committee on Health Coverage, Insurance and Financial Services has given bipartisan support to four of the bills.
“When it comes to health care, Maine needs to be fighting for patients over profits. This is especially true when it comes to prescription drugs. Nobody should have to choose between putting food on the table, heating their home or taking their medicine,” Senate President Troy Jackson, a Democrat from Allagash, said in a statement. He sponsored two of the bills.
“It’s high time we took action to lower the cost of prescription drugs in this country,” he added. And I don’t mean making minor progress around the margins. We need to tackle the prescription drug crisis head-on.”
The most comprehensive, LD 1499, would establish a prescription drug affordability board. The board would, for the first time, review how drugs are priced. Manufacturers would be asked to provide information to justify their prices and any price increases.
Such transparency will begin to answer questions about why some common medications have recently risen in price, why different groups are charged different amounts for the same medications and why some specialty drugs are so expensive.
Based on this review, the board would set prescription medication spending targets for public entities based on a 10-year-rolling average.
LD 1162, a bill from Democratic Senator Eloise Vitelli of Arrowsic, is also about transparency. It would broaden the information about drug pricing that is collected by the Maine Health Data Organization in an effort to zero in on the reasons that overall costs are increasing, such as rising ingredient costs, marketing and price negotiations with insurance companies and pharmacy benefit managers.
Pharmacy benefits managers negotiate drug prices with public and private insurance providers, with little transparency of how prices are set. They are often incentive for the manger to keep drug prices high so they are paid more. In addition to providing more information to insurers, an amended version of LD 1504, sponsored by Sen. Heather Sanborn, D-Portland, would require PBMs to pass manufacturer rebates along to consumers or to the insurance carrier to lower insurance premiums. It would also require that consumers be offered the cash price for a drug if it is lower than their co-pay.
Another bill from Jackson, LD 1272, Jackson would allow Maine to create a wholesale prescription importation program to acquire lower priced medications from Canada. While this could help some Maine residents, the state would need a waiver from the federal government to import medications from Canada and not all medications would be available.
Sen. Susan Collins is currently working in Congress on a comprehensive bill to lower drug costs that includes many of the same fixes, including more disclosure of how drug prices are set and pharmacy benefit manager reforms. In a recent meeting with the BDN, she predicted that a comprehensive bill would soon come of the Senate Committee on Health, Education, Labor and Pension.
Late last month, Collins and two other Republican senators introduced the Prescription Drug Price Reporting Act. It would create a web-based federal database that would include pricing and rebate information and require drug companies to explain any price increases.
Lowering prescription drug prices is also a priority for Sen. Angus King, who recently introduced legislation to require more pricing transparency in drug advertising. He has cosponsored other bills to allow importation from Canada and to allow Medicare to negotiate prescription drug prices.
With three-quarters of Mainers saying they are concerned about prescription drug costs, this work is vital. The same polling found strong support in Maine for many of the fixes currently before the Legislature.
Seeking to address the problem from many angles - transparency, importation and price negotiations - and at both the state and federal level makes sense. It will take a comprehensive, sustained approach to reverse the pricing trend that puts the health of too many Americans at risk.