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States Take On High Drug Costs

AJN, American Journal of Nursing: December 2019 - Volume 119 - Issue 12 - p 13
doi: 10.1097/01.NAJ.0000615716.86020.55
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Abstract

Figure
Figure:
Protesters gather at the Cambridge, Massachusetts, offices of the multinational pharmaceutical company Sanofi to protest the high price of insulin. Photo by Marilyn Humphries / The Image Works.

States are taking the lead in making prescription drugs more affordable. As of September, 33 states passed 51 laws aimed at drug pricing, affordability, and access, according to the September 9 Kaiser Health News. The new laws authorize a range of cost-control measures such as allowing prescription drugs to be imported, screening for excessive price increases, and establishing oversight boards to set drug prices.

A main target are companies known as pharmacy benefit managers (PBMs), which act as middlemen for drug manufacturers, insurance companies, and pharmacies. Some PBMs impose “gag rules” that prevent pharmacists from telling customers it would be cheaper to pay cash for their drugs rather than the copays required by their insurance plans.

So far, Colorado, Florida, Maine, and Vermont have set up programs to import cheaper prescription drugs from Canada. Drugs cost less in Canada and in some other countries because their governments negotiate directly with drugmakers for lower prices.

Maryland and Maine have created new state agencies to review drug costs and act when prices exceed a certain threshold; New Jersey and Massachusetts are considering similar measures. Maryland will monitor the list prices of drugs purchased by state and local government agencies and pay particular attention to drugs whose prices increase by $3,000 or more in a year, as well as new drugs costing $30,000 or more a year.

Most states now have transparency laws that publicly identify drugs with price increases of 10% or more a year. A new law in Oregon requires drugmakers to warn the state 60 days in advance of planned price increases to help physicians and patients adjust.

At the federal level, House Speaker Nancy Pelosi has proposed that Medicare negotiate prices directly with drugmakers on 250 products that don't have competition from at least two generic biosimilar or interchangeable biologics. Pelosi and the Trump administration, in separate proposals, also favor setting drug prices in line with those of countries whose health systems negotiate on the basis of a drug's actual value.—Carol Potera

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