Category: Uncategorized

BY MCKENZIE BEARD with research by RACHEL ROUBEIN
PUBLISHED: WEDNESDAY, FEBRUARY 22ND, 2023

Happy Wednesday and welcome back to The Health 202, where the early blooming cherry trees in the District have us excited for spring on this chilly morning. 

Today’s edition: The results are in for the closely watched Wisconsin Supreme Court primary election. Abortion rights groups in Ohio took the first step toward putting a constitutional amendment protecting abortion rights on the ballot this fall. But first … 

Democrat-led states are focusing on prescription drugs, flavored tobacco and single-payer health care

The 2023 legislative session is moving full steam ahead.  

We recently wrote about legislation red states are pursuing. In today’s edition, we take a look at blue states, where lawmakers are moving to ban flavored tobacco products, curb prescription drug prices and expand health coverage for residents.

It’s still unclear how many of these initiatives will become law given industry lobbying and political barriers. But here’s a look at some of the legislation on tap in states where Democrats set the legislative agenda:

Prescription drug affordability boards

One idea gaining traction to tamp down on pharmaceutical prices is to create a prescription drug affordability board (PDAB). These nongovernmental bodies are typically staffed by health-care experts who are tasked with identifying high-cost drugs and suggesting policy options to make them more affordable for consumers and state health budgets.

Lawmakers have introduced legislation to establish their own PDAB in at least five blue states this session: Minnesota, New Mexico, Illinois, Michigan and Rhode Island. If enacted, they’d join seven other states that have passed laws creating the independent panels since 2019.

The authority that PDABs have to drive down drug prices varies by state; although, since many are still in their infancy, it remains to be seen what will be most effective. We’re watching Colorado and Washington particularly closely, since their boards are empowered to set upper payment limits on certain high-price drugs that its members deem unaffordable.

• “This is really about having something in between the monopolistic power of a large entity and individual consumers that have to buy things from that large entity to live,” said Minnesota state Rep. Zack Stephenson (D), a primary sponsor of legislation that would establish a PDAB in his state.  

Banning flavored tobacco sales

Democrats in at least eight states are looking to ban the sale of most flavored tobacco and e-cigarette products.

Lawmakers behind the proposals argue that flavors are at the root of the nation’s teen vaping crisis, given evidence suggests young people gravitate toward e-cigarette devices that come in flavors like cotton candy or bubble gum.

The big question: Do the statewide bans include menthol cigarettes?  In recent years, local governments and voters have increasingly taken matters into their own hands to crack down on the minty products while they wait for the Food and Drug Administration to decide whether to outlaw them nationally — a policy shift that the Biden administration proposed last year.

Oregon and Vermont are among the states looking to prohibit the sale of menthol-flavored products, with supporters contending that a ban would reduce tobacco-related health disparities and save lives. Many leading health and civil rights groups agree, arguing that the tobacco industry has a long history of aggressively marketing to Black communities, fueling higher rates of preventable illnesses and deaths.

But lawmakers in Connecticut filed a proposal that make an exception for menthol cigarettes, citing concerns that prohibition could give rise to clandestine sales and exacerbate existing issues around racial profiling, discrimination and law enforcement.

One thing is certain: If passed, the new policies would almost certainly face legal blowback. Last year, tobacco companies asked the Supreme Court to block California from enforcing its ban on flavored products, even after nearly two-thirds of state residents supported it in the November elections.

Looking at single-payer

Democratic lawmakers in at least eight states have introduced ambitious proposals pressing for a single-payer health-care model to provide coverage for all residents.

The effort comes as upward of 15 million people are expected to lose their health insurance this year. State health officials will begin the sizeable task of determining who is no longer eligible for Medicaid after three years of keeping enrollees continuously enrolled in the program during the pandemic (although some are expected to qualify for financial aid on the Obamacare exchanges or obtain employer-sponsored coverage). 

Oregon and Maryland are among the states seeking to establish a commission charged with developing a plan for implementing a single-payer system. States including Connecticut and Minnesota are looking to set up a committee to study the costs and benefits of transitioning from a multi-payer system to a single, state-administered payer.

But these measures face long odds to become law this session. Dozens of single-payer proposals have been introduced in state legislatures across the country since the passage of the Affordable Care Act in 2010, and as it stands, just Vermont has managed to carry its plan over the finish line — only for it to be shelved three years later due to cost concerns.

Nevertheless, Democrats behind the proposals say they hope the bills will boost the campaign to establish single-payer systems in the states, as efforts to implement universal health care have sputtered on the federal level.  

Reproductive wars

The results of the Wisconsin primary that could decide abortion ban fate

Voters narrowed the field to two candidates — one liberal and one conservative — for the Wisconsin Supreme Court yesterday in a race that will determine the balance of the court, The Post’s Patrick Marley reports. 

Officially the race is nonpartisan, but Milwaukee County Judge Janet Protasiewicz is aligned with Democrats and Daniel Kelly, a former state Supreme Court justice, is aligned with Republicans. The two advanced in Tuesday’s primary election and will now battle it out in a 42-day sprint to an April 4 general election that is sure to see record spending. 

For 14 years, conservatives have controlled the court. But that could change just as a lawsuit over the state’s 1849 ban on most abortions is winding its way through the courts and is likely to come before the justices in the coming years. Abortion has been a centerpiece of the race with groups on both sides of the debate issuing endorsements, crafting get-out-the vote efforts and putting money into the race.

Ohio groups take key step to put abortion rights on the 2023 ballot

Abortion rights groups took a step forward yesterday in their quest to put a measure to Ohio voters in the fall aimed at enshrining abortion rights into the state constitution.

Ohioans for Reproductive Freedom and the Ohio Physicians for Reproductive Rights submitted an amendment and a summary to the state’s Republican attorney general for review. The proposed ballot measure would guarantee the right to fertility treatment, contraception, abortion and more. The text of the amendment states that “abortion may be prohibited after fetal viability” — which is typically around 22 to 24 weeks into pregnancy — with exceptions for the life and health of the mother.

What’s next: The state’s attorney general has up to 10 days to approve the summary of the amendment. It then also needs sign-off from the Ohio Ballot Board before abortion rights groups can begin gathering the necessary 413,00 signatures to attempt to officially get the measure on the fall ballot. 

In a preview of the fight to come, the language submitted yesterday is already receiving pushback from antiabortion groups, with SBA Pro-Life America calling the proposal “extreme.”

On the Hill

First in The Health 202: Senate Democrats call on HHS to address ‘junk plans’

More than 30 Democratic senators are urging the federal health department to limit the Trump administration’s expansion of short-term health insurance plans — cheaper, skimpier coverage that isn’t required to comply with Obamacare’s consumer protections. 

In a letter sent this morning, Sens. Tammy Baldwin (D-Wis.) and Chris Murphy (D-Conn.) led lawmakers in urging the Department of Health and Human Services to take “immediate action” since Medicaid’s pandemic-era continuous enrollment requirement ends March 31, at which point millions of beneficiaries are expected to begin to lose coverage through the safety net program and will need to enroll with another insurer in the coming months.  

Key context: It’s been over two years since Biden signed an executive order directing federal agencies to review Trump-era regulations. In a recent rulemaking agenda, the federal health department said it intends to issue a proposal by April, but that timeline isn’t binding. HHS didn’t immediately respond to a request for comment.

BY BARBARA WEBBER
PUBLISHED: SUNDAY, NOVEMBER 20TH, 2022

Gov. Michelle Lujan Grisham’s reelection is good news for New Mexicans concerned about the high cost of prescription drugs. The governor’s Prescription Drug Task Force recently made several important recommendations for the state to help make prescription drugs more affordable and accessible for New Mexicans.

When the Legislature convenes in 2023, it should pass comprehensive reform that expands on those recommendations by incorporating three foundational principles — transparency in drug pricing; ending profiteering; and creating an independent body with expertise, focus and a mission to negotiate fairer and more affordable prescription drugs for New Mexico consumers.

Chances are you or one of your family members has a story about paying too much for a medication. Prescription drugs are critical to the health of many New Mexicans, and people across the state are struggling to afford the prescriptions they need, often having to choose between their medications and other necessities like rent and groceries.

Nearly half of New Mexicans report having skipped taking medication or not filling a prescription because of cost concerns. Prescription drug companies are the only businesses in the health care industry whose rates are not regulated, and Americans pay at least three times as much for the same name-brand drugs as other countries. The Journal of the American Medical Association reports 35 big drug companies raked in $8.6 trillion in profits between 2000 and 2018.

It’s time to stand up to the big drug companies with a comprehensive solution to lower prescription drug prices in New Mexico, because drugs don’t work if people can’t afford them. Here are three key core reforms:

• Transparency in drug pricing: All participants in the supply chain for providing prescription drugs in New Mexico, including pharmaceutical companies and pharmacy benefit managers, should be required to open their books about the true cost of manufacturing, marketing and supplying drugs.

Consumers have a right to know what goes into determining the list price for drugs and what contractual agreements affect what they pay and what insurers are reimbursed. Other states have passed legislation requiring drug companies to provide justification for price increases over 10 percent, reporting on their profits for the drug, why they need the increase, how much they plan to spend on marketing and advertising, and other measures to hold them accountable.

• Ending profiteering across the entire prescription drug supply chain. Drug manufacturers and pharmacy benefit managers must stop putting profits before patients and end anti-consumer practices, including “spread pricing,” in which pharmacy benefit managers charge payers more for a prescription drug than what they reimburse pharmacies (and then pocket the difference). Benefit managers reform, including ending spread pricing, is a starting point.

Creating a Prescription Drug Affordability Board to hold drug companies accountable and incentivize lower prices — an independent panel is needed to implement market strategies that can help lower prices. Some of the most promising strategies include utilizing a statewide benefits manager to negotiate fair and affordable drug prices and provide drugs at the same low cost as Canadians. Many states, including Colorado, Oregon and Maryland, have passed board legislation, and creating a Prescription Drug Affordability Board is among the top recommendations of the bipartisan National Conference of State Legislatures.

New Mexico can and should lead the way on comprehensive prescription drug price reform in the 2023 legislative session and should base its approach on improving transparency, ending profiteering, and negotiating fairer and more affordable prescription drugs for New Mexico consumers.

Barbara Webber is executive director of Health Action New Mexico and a leading voice with New Mexico Consumers for Affordable Prescriptions.

BY JAMES JIMENEZ
PUBLISHED: SATURDAY, OCTOBER 15TH, 2022

The fall campaign season is here. This is when legislative and statewide candidates should start getting specific about solutions to the real problems New Mexicans face every day.

It’s no secret that rising prices on everything from housing to groceries are hurting families. One issue that should be at the top of mind for candidates to ease costs is improving access to affordable medications. 

In August, Congress passed the Inflation Reduction Act, authorizing Medicare to negotiate directly with drug companies to help lower some prescription drug prices. It is a step in the right direction, but New Mexico can and should do more to fill in the gaps left by the federal legislation. 

NMVC Action Fund is a nonprofit organization advancing policies that support concrete improvements in the well-being of New Mexico’s children, including early childhood and public education, healthcare, food security, and economic well-being. 

Drug prices might not seem like an issue impacting children. However, we know kids do better when the people they love can make ends meet, and high drug prices harm their parents, grandparents, friends, and neighbors. 

One easy issue for candidates to support is the creation of a Prescription Drug Affordability Board with a mandate to evaluate the cost of medications, hold big drug companies accountable, and negotiate more affordable prices for New Mexicans. 

A board like this should have the authority to help make prescription drugs more affordable for New Mexicans by examining the entire drug supply chain, negotiating more affordable prices, and building upon the state’s efforts to lower health care costs for all residents.

During just the first seven months of this year, the pharmaceutical industry has hiked drug prices 1,186 times, according to a new report from Patients for Affordable Drugs. The increase in prices is outpacing inflation. The consistent cost increase is happening to drugs to treat conditions including leukemia, blood disorders, lupus and psoriasis. Nearly 90 percent of all price hikes in 2022 have been on brand-name drugs, which carry the highest prices on the market. 

Americans pay four times as much for the same medicines as people in other countries. According to a statewide survey, nearly half of New Mexicans have skipped taking medication or not filled a prescription because of cost concerns. This is a problem we can tackle. 

The bipartisan National Conference of State Legislatures released a report stating that a Prescription Drug Affordability Board is a common sense way to determine the cost of prescription drugs and make medications more affordable. In August, the Legislative Health and Human Services Committee committed to draft PDAB legislation for the 2023 session. Now we need to get it passed.

It’s time for legislative and statewide candidates to stand for New Mexico patients and consumers and commit to action. Establishing a Prescription Drug Affordability Board will give New Mexico an independent advocate who can evaluate prescription drug costs and negotiate reasonable prices.

BY KARIN SANCHEZ
PUBLISHED: WEDNESDAY, AUGUST 17TH, 2022

LAS CRUCES, N.M. (KFOX14/CBS4) — New Mexico Governor Michelle Lujan Grisham, the U.S. Secretary of Health and Human Services Xavier Becerra, and U.S. Senators Ben Ray Lujan and Martin Heinrich discussed with the community in a closed-off roundtable how the Inflation Reduction Act will lower the price of prescription drugs.

President Biden signed the inflation reduction act on Tuesday, August 6, which allowed Medicare to negotiate the cost of prescription drugs.

Leaders in New Mexico looked to take that one step further.

While Medicare is allowed to lower the cost of prescriptions, Governor Michelle Lujan Grisham said the state needs to fill in gaps within the Inflation Reduction Act to improve access to affordable medication. 

The state of New Mexico looked to pass a bill called the Prescription Drug Affordability Act.

The bill would create an advisory board, which leaders said would consist of appointed experts that would negotiate on the behalf of New Mexicans to hold drug companies accountable and incentivize lower prices for prescription drugs.

“This President, this senate, this secretary got it over the finish line and now New Mexicans are going to get access to life-saving treatment in ways they just didn’t have before,” said Michelle Lujan Grisham, New Mexico Governor.

The U.S. Secretary of Health and Human Services said New Mexicans will not be seeing a drastic change in medication prices until 2026.

LAS CRUCES, NM – New Mexico Consumers for Affordable Prescriptions today called for the creation of a Prescription Drug Affordability Board at a roundtable discussion with the state’s congressional delegation and Governor Michelle Lujan Grisham, advocating that all New Mexicans would benefit from an independent board with the authority to evaluate the cost of medications and negotiate more affordable rates for New Mexicans.

A key provision of the federal Inflation Reduction Act to allow Medicare to negotiate drug prices is an important step forward for seniors. However, soaring prescription drug costs affect all New Mexicans, and the Inflation Reduction Act underscores the need for state action to fill in the gaps and improve access to affordable medications.

“New Mexicans continue to struggle to afford the medications they need,” said Barbara Webber, Executive Director of Health Action New Mexico. “A Prescription Drug Affordability Board will hold drug companies accountable and negotiate on consumers’ behalf to lower the cost of drugs. I want to thank New Mexico’s federal delegation and Governor Lujan Grisham for their focus on this critical issue.”

A Prescription Drug Affordability Board (PDAB) would consist of independent appointed experts to negotiate on behalf of New Mexico consumers, hold drug companies accountable, and incentivize lower prices for prescription drugs. PDAB strategies may include:

• Creating and utilizing a statewide benefits manager to lower drug costs.
• Securing the lowest-cost drugs available.
• Rewarding New Mexicans when then use discounts and direct mail drug services.
• Ensuring New Mexicans pay the same low cost for drugs as Canadians.

“Enough is enough,” said Joseph P. Sanchez, AARP New Mexico State Director. “While the Inflation Reduction Act is an important step forward for seniors, soaring drug costs affect all New Mexicans, and federal action underscores the need for the state to fill in the gaps and improve access to affordable medications for others, including those on Medicaid, workers who have health insurance through public and private sector coverage, as well as the uninsured. With the establishment of the Prescription Drug Affordability Board, New Mexicans will have an independent advocate that can evaluate prescription drug costs and negotiate reasonable prescription drug prices.”

The Legislative Health and Human Services endorsed the creation of a PDAB at its November 2021 hearing where lawmakers questioned the pharmaceutical industry on anti-consumer practices, including new evidence from the most recent report of the Institute for Clinical and Economic Review on unsupported price increases.

The creation of a PDAB is among the top recommendations for states to determine the true cost of prescription drugs and help make medications more affordable for consumers, according to a bipartisan report by the National Conference of State Legislatures.

• On average, Americans pay three times as much for the same medicines as people in other countries.
• The Journal of the American Medical Association reports 35 big drug companies raked in $8.6 billion in profits between 2000 and 2018.
• Nine of the top ten companies spend more money on marketing and advertising than they do on researching new drugs.
• Nearly half of New Mexicans have skipped taking medication or not filled a prescription because of cost concerns.

Advocates have launched a website, www.newmexicocap.org, with information about drug pricing and state policy options to reduce drug costs.

CONTACT: Barbara Webber, Executive Director, Health Action New Mexico 505-508-6531 (cell) barbara@healthactionnm.org

BY BARBARA WEBBER AND ALEX CVIJANOVICH / ALBUQUERQUE JOURNAL
PUBLISHED: TUESDAY, AUGUST 2ND, 2022

As Congress debates adding a prescription drug provision to the budget reconciliation, one thing is certain – while important, proposed federal action to allow Medicare to negotiate drug prices will not go far enough to improve access to affordable medications for New Mexicans. We need state action to create an independent board with the authority to evaluate high-priced drugs and negotiate reasonable rates for consumers.

Too many New Mexicans are struggling to afford the prescription drugs they need, often having to choose between their medication and other necessities, like rent and groceries. Rising drug prices affect all New Mexicans including those on Medicare and Medicaid, workers who have health insurance through public and private sector coverage, as well as the uninsured, and it is critical the state take action to ensure all state residents can access affordable medications, because drugs don’t work if people can’t afford them.

That’s why New Mexico Consumers for Affordable Prescriptions is building support across the state for legislation in 2023 to create a Prescription Drug Affordability Board (PDAB) with a mandate to evaluate the cost of medications, hold big drug companies accountable, negotiate more affordable rates for New Mexicans and incentivize lower prices.

Nearly half of New Mexicans have skipped taking medication or not filled a prescription because of cost concerns. And the big drug companies have taken advantage of the pandemic to raise prices. On average, Americans pay four times as much for the same medicines as people in other countries, and nine of the top 10 pharmaceutical companies spend more money on advertising than they do on researching new drugs.

Enough is enough. Creating a PDAB is among the top recommendations for our state to determine the true cost of prescription drugs and help make medications more affordable for consumers, according to a bipartisan National Conference of State Legislatures report.

Last year, the Legislative Health and Human Services Committee stood up for New Mexico patients and consumers by endorsing the creation of a PDAB. During a day-long hearing on the high cost of drugs, the committee demanded answers from pharmaceutical industry representatives on why prices continue to skyrocket as pharmaceutical company profits soar.

The committee’s work should continue during its August meeting to finalize a prescription drug affordability board for approval in the 2023 legislative session. Prices for 460 prescription drugs increased by an average of 5.2% in 2020 – more than triple the rate of inflation – according to an analysis from the health care research firm, 3 Axis Advisors. And the Journal of the American Medical Association reports 35 big drug companies raked in $8.6 trillion in profits between 2000 and 2018.

It’s time for the governor and state legislators to stand up to the big drug companies, and they can be confident their constituents are with them. Nine in 10 New Mexicans are either very or somewhat concerned about the cost of prescription drugs, and nearly eight in 10 favor the creation of a PDAB, according to a statewide survey conducted by research firm GBAO.

New Mexico needs to create a Prescription Drug Affordability Board now with the authority to examine the entire drug supply chain, negotiate more affordable prices on expensive drugs that create significant affordability problems for New Mexicans, and build upon New Mexico’s efforts to lower health care costs for all residents.

BY BARBARA WEBBER AND ALEX CVIJANOVICH / SANTA FE NEW MEXICAN
PUBLISHED: SUNDAY, JULY 31ST, 2022

As Congress debates a prescription drug provision, one thing is certain: While important, proposed federal action to allow Medicare to negotiate drug prices will not go far enough to improve access to affordable medications for New Mexicans. We need state action to create an independent board with the authority to evaluate high-priced drugs and negotiate reasonable rates for consumers.

Too many New Mexicans are struggling to afford the prescription drugs they need, often having to choose between their medication and other necessities, like rent and groceries. Rising drug prices affect all New Mexicans, including those on Medicare and Medicaid; workers who have health insurance through public and private sector coverage; and the uninsured, and it is critical the state take action to ensure all state residents can access affordable medications because drugs don’t work if people can’t afford them.

That’s why New Mexico Consumers for Affordable Prescriptions is building support across the state for legislation in 2023 to create a Prescription Drug Affordability Board with a mandate to evaluate the cost of medications, hold big drug companies accountable, negotiate more affordable rates for New Mexicans and incentivize lower prices.

Nearly half of New Mexicans have skipped taking medication or not filled a prescription because of cost concerns. And the big drug companies have taken advantage of the pandemic to raise prices. On average, Americans pay four times as much for the same medicines as people in other countries, and nine of the top ten pharmaceutical companies spend more money on advertising than they do on researching new drugs.

Enough is enough. Creating an affordability board is among the top recommendations for our state to determine the true cost of prescription drugs and help make medications more affordable for consumers, according to a bipartisan National Conference of State Legislatures report.

Last year, the Legislative Health and Human Services Committee stood up for New Mexico patients and consumers by endorsing the creation of a Prescription Drug Affordability Board. During a daylong hearing on the high cost of drugs, the committee demanded answers from pharmaceutical industry representatives on why prices continue to skyrocket as pharmaceutical company profits soar.

The committee’s work should continue during its August meeting to finalize a prescription drug affordability board for approval in the 2023 legislative session. Prices for 460 prescription drugs increased by an average of 5.2 percent in 2020 — more than triple the rate of inflation — according to an analysis from the health care research firm 3 Axis Advisors. And the Journal of the American Medical Association reports 35 big drug companies raked in $8.6 trillion in profits between 2000 and 2018.

It’s time for the governor and state legislators to stand up to the big drug companies, and they can be confident their constituents are with them. Nine-in-10 New Mexicans are either very or somewhat concerned about the cost of prescription drugs, and nearly 8 in 10 favor the creation of a Prescription Drug Affordability Board, according to a statewide survey conducted by research firm GBAO.

New Mexico needs to create a Prescription Drug Affordability Board now with the authority to examine the entire drug supply chain, negotiate more affordable prices on expensive drugs that create significant affordability problems for New Mexicans and build upon New Mexico’s efforts to lower health care costs for all residents.

BY REP. PAMELYA HERNDON / ALBUQUERQUE DEMOCRAT
PUBLISHED: WEDNESDAY, JANUARY 19TH, 2022 AT 12:02AM

In a first for New Mexico, lawmakers put the pharmaceutical industry on the hot seat recently with a daylong hearing on the high cost of prescription drugs, and the Legislative Health and Human Services Committee stood up for New Mexico patients and consumers by endorsing the creation of a Prescription Drug Affordability Board. For the many New Mexicans struggling to afford the medications they need, Gov. Michelle Lujan Grisham can add to her strong record as a public health leader by including the bill on her priority list for this legislative session.

Creating a PDAB is among the top recommendations to determine the true cost of prescription drugs and help make medications more affordable for consumers, according to a bipartisan National Conference of State Legislatures report. A PDAB would regulate prescription drugs with costs that greatly impact New Mexicans, including high-cost, brand name medications. The board would consider a range of economic factors when setting appropriate payment rates for reviewed drugs, allowing pharmaceutical manufacturers the opportunity to justify drug costs. Once a fair payment rate is determined, the board sets an upper payment limit that applies to all purchasers and payer reimbursements in New Mexico, ensuring lower costs benefit consumers.

The legislative committee heard from patients across New Mexico who have seen drug prices rise even during the pandemic and was presented with disturbing evidence of greed and anti-consumer practices of the pharmaceutical industry from the most recent report of the Institute for Clinical and Economic Review on unsupported price increases.

The story of one popular medication illustrates the urgency of protecting patients and holding drug companies accountable. Humira, created by AbbVie, is used to treat rheumatoid arthritis, Crohn’s Disease, colitis and other illnesses and is the No. 1-selling drug in the United States and the world. From 2003 to 2021, Humira’s price has increased 470%, from $16,600 to $77,000 per year. Despite the fact Humira’s patent was to end in 2016 and allow for more affordable biosimilar alternatives, AbbVie has blocked them through a tactic called “Pay for Delay,” pushing the expiration to 2023 and costing U.S. consumers $19 billion, according AHIP, the Association of Health Insurers. In 2020 alone, AbbVie collected $16 billion in U.S. net revenue.

Pharma greed is not limited to AbbVie. Prices for 460 prescription drugs increased by an average of 5.2% in 2020 – more than triple the rate of inflation – according to an analysis from health care research firm 3 Axis Advisors. And the Journal of the American Medical Association reports 35 drug companies raked in $8.6 trillion in profits between 2000 and 2018.

It is past time for action. Americans pay four times as much for the same medicines as people in other countries, and 44% of New Mexicans report they have skipped taking medication or not filled a prescription because of cost concerns, according to a recent statewide survey.

Prescription drug companies are the only businesses in the health care industry whose rates are not regulated. It’s time to hold them to the same standard as other health care providers. Creating a PDAB is a common-sense solution to drive down the cost of medication. I applaud the Health and Human Service Committee’s endorsement and urge the governor to push for the bill this session.

Updated: Dec. 26, 2021, 4:09 p.m. | Published: Dec. 26, 2021, 8:58 a.m.

By Emily Green, The Lund Report

Genetic therapies from the global biopharmaceutical company Bristol-Myers Squibb topped the list of pricey new drugs reported to the program, which was created by the Legislature in 2018 to increase transparency around drug costs. The 2021 report draws from data collected since the program’s last annual report was released in October 2020.

Abecma was the most expensive at $419,500 for a single infusion, made from a patient’s own immune cells, followed by Breyanzi at $410,300 for the one-time treatment. Both are CAR-T (chimeric antigen receptor T-cell) therapies used to treat certain types of cancer.

Last year, Tecartus, a brand-name, one-time therapy for mantle cell lymphoma from Kite Pharma, topped the list at $373,000.

In the past year, Oregonians spent more on Humira than any other drug, with the 10 insurers that report to the program indicating that $93.5 million was paid for 19,225 prescriptions. It’s the third year in a row that the drug, used to treat rheumatoid arthritis and ulcerative colitis, has topped the list. A 7.4% price increase for the drug earlier this year has led to $1.4 billion more in spending in the U.S. These highlights from the Prescription Drug Price Transparency Program’s 2021 annual report were also shared during the program’s third annual public hearing, held virtually on Wednesday, Dec. 8.

The program was established under the Prescription Drug Price Transparency Act in 2018. It was intended to be a first step toward combating sky-high drug prices and spending. Companies are required to report new drugs and price increases of existing drugs to the program, which is run by Oregon’s Department of Consumer and Business Services.

That applies when the list price meets certain price thresholds: when the price increases by more than $100 a month (if that equates to more than a 10% increase over the previous year) and when a new drug is priced at more than $670 a month, which is the threshold for the specialty tier of Medicare Part D, which covers drug costs.

So far, 193 new high-cost drugs have been reported to the program this year. The majority, at 63%, are generic, and 41 of the reported drugs are antineoplastics and adjunctive therapies — in simpler terms, cancer treatments.

“This is continuing the trend that most of the highest cost drugs that we see tend to be for cancer, or for other sort of difficult-to-treat disease states that don’t have a lot of treatments out there for them already,” Numi Lee Griffith, senior policy advisor for the Division of Financial Regulation, said during the hearing. “And they tend to be biologics.”

She said biologics are large molecule drugs produced inside living cells, as opposed to small molecule drugs, created with chemical processes in a laboratory. The Food and Drug Administration reported that the price transparency program’s list topper, Abecma, is the first cell-based gene therapy it has approved for the treatment of multiple myeloma, a cancer that forms in plasma cells.

“Each dose of Abecma is a customized treatment created by using a patient’s own T-cells, which are a type of white blood cell, to help fight the myeloma,” stated a release from the FDA. “The patient’s T-cells are collected and genetically modified to include a new gene that facilitates targeting and killing myeloma cells. Once the cells are modified, they are infused back into the patient.”

The greatest price increase reported to the state program was from Nostrum Laboratories for a generic drug that saw a hike of 778%. The average cost increase was 27% for generics and 13% for brand-name drugs.

Public testimony from AARP Oregon, OSPIRG and others during the hearing applauded the program’s efforts but agreed more must be done to rein in drug costs.

Morgan shared with panelists how her father was told to get his affairs in order after it was discovered he suffers from a rare gene mutation. Her family was relieved when his oncologist told them a new drug could save his life. But it came with a price tag of $4,000 a month.

They “liquidated assets” and took other measures to pay for it. The following year, that price tag rose to $10,000 a month, for the same drug. She said her dad is alive because her sister purchases the drug in Holland, where it costs less than $300 a month, and flies it to the U.S. multiple times a year.

Griffith, who served as the program’s coordinator in the past, noted in her presentation that the number of significant price increases is trending down, but the average launch price of new drugs is simultaneously rising.

“What this really suggests is a change in behavior from manufacturers, that rather than increasing prices throughout lifespan of a drug, they’re building all of that all their profit pulls into the beginning of the life cycle,” she said. This way they have fewer and smaller price increases later on, “which allows them to not send reports to programs like ours,” she said.

Fifteen states have drug price reporting programs similar to Oregon’s. Also incentivizing drug companies to set high prices out of the gate is the Oregon Health Plan drug rebate policy, said Griffith.

“When a drug is purchased through Medicaid, the manufacturer is required to give an automatic rebate that basically locks the price to the rate of inflation,” she said. “That kind of gives an incentive for drug companies to just price real high and avoid those price increases, because they won’t be able to reap profits through Medicaid for price increases because of the rebate program.”

Earlier this year, The Lund Report found that loopholes and a lack of staffing have hampered the impact of the price transparency program.

Pricing strategies that can drive the increases are often shielded from scrutiny in the name of “trade secrets,” with the onus placed on the state to prove otherwise. Doing so has been a challenge given the program’s small staff and the large volume of reports it must process, making publicly viewable information within the program’s database sparse.

Antonio Vargas, a research analyst for the program, said during the hearing that staff has been busy getting more information inputted into the online database where the public can view any report listed with a status of “Filing Complete.”

“This is a major milestone of the program,” he said. In an example of a viewable drug report in the database that Vargas showed during the hearing, the manufacturer had marked that its marketing data was a trade secret; however, the information was disclosed.

“You can see the original or redacted data depending on the department’s determination to disclose or not disclose it,” Vargas said.

Program staff included an explanation of the disclosure in the example. The program also collects financial information from drug companies relating to four direct costs related to a drug: marketing, safety and effectiveness research, distribution and manufacturing.

Both generic and brand-name drug makers report manufacturing as the largest expense. Marketing comprised 20% of the pie for brand-name drugs. Whether the transparency programs in Oregon and other states have impacted drug prices is up for debate.

Prices increases began to fall a year before Oregon’s — the first in the nation — was implemented. Griffith said Medicaid rebate programs, as well as public pressure to avoid steep price increases after stories of gouging made headlines, contributed to the decrease.

“So you can’t say the transparency was the cause of that particular change in behavior,” she said.

Rep. Rachel Prusak, D-Tualatin, who is chair of the House Interim Committee On Health Care and a family nurse practitioner, chimed in following Griffith’s presentation.

She said while she was listening to the hearing, she received a message from a patient’s family member who was concerned because Victoza, a diabetes drug, is priced at $3,300 and will be a $600 copay to the patient.

“What Rep. Prusak just said really underlines what I’m hoping to highlight,” said Bandana Shrestha, speaking on behalf of AARP Oregon. “Our members, and I would say all Oregonians, are really sick and tired of paying the highest drug prices in the world for critically needed medication. We pay three times what other countries pay for brand-name drugs.”

To demonstrate her point, she pointed to a popular drug that can be prescribed to work with chemotherapy.

“In 2018, there were 393,000 Oregonians that were diagnosed with cancer, and Revlimid is a cancer drug that may be really helpful for a lot of folks,” she said. “Between 2015 and 2020, the price of this drug went from $187,000 to $267,000 per year. And this year, the price has gone up to about $280,000 — I mean, I can’t imagine who would be able to pay for that.”

You can reach Emily Green at emily@thelundreport.org. This article was originally published by The Lund Report, a nonprofit, non-partisan news site that delivers exclusive and in-depth coverage of health care and the health care industry in Oregon.