Legislative Update: Week of November 11, 2019
On Thursday, the Massachusetts State Senate released its drug pricing bill, S.2397, an act relative to pharmaceutical access, costs, and transparency (PACT Act). As drafted, this bill would require drug manufactures to submit 60 days advanced notice of branded drug price increases over 20% of WAC price and generic drug price increases of 200% of WAC (for generics over $100); and 30 days advanced notice of drug launch. CHIA is given the authority to analyze factors related to drug costs from drug manufacturers and PBMs; and HPC can use its discretion to determine if a drug is reasonably priced, and create a value for that drug. If they deem the drug is unreasonably priced, they can ask the manufacturer to put together an Access Improvement Plan that outlines how it will increase patient access, and ultimately lower costs. Manufacturers will face monetary penalties if they fail to follow the plan in good faith, or will be subjected to a public hearing where representatives are required to testify, if they fail to submit an Access Improvement Plan. The bill also includes measures to create a licensing process for PBMs; caps out-of-pocket costs for insulin at $25 a month, eliminating deductibles and coinsurance; and requires pharmacists to notify patients when the retail price of a prescription drug is cheaper than what it would cost with insurance. MassBio’s CEO Bob Coughlin issued the below statement on the bill:
“Legislative solutions already exist to ensure patient access to prescription drugs – solutions that aren’t arbitrary and punitive. Restricting the use of step therapy, non-medical switching, and extending the state’s copay assistance law are all simple, lasting solutions with broad support across the Legislature. That’s in strong contrast to the Senate’s proposal to allow the state to determine the appropriate price of a drug, and either fine or publicly shame a company that may disagree with the state’s valuations – without subjecting any other parts of the healthcare sector to such penal action.
The spending growth rate in Massachusetts for prescription drugs has declined three years in a row, coming in at 3.6% between 2017 and 2018. That’s in-line with the state’s benchmark growth rate of 3.1%. The Senate has proposed a bill focused only on drug pricing when the state data show that out-of-pocket costs are the real problem, with health insurance premiums and patient cost-sharing growing at 5.6% between 2017 and 2018 inflicting significant, direct financial burden on patients.”
In Federal News, the House vote on The Lower Drug Costs Now Act (HR 3) has been delayed until the beginning of December as the House awaits the results of a full Congressional Budget Office score.
Debate on Senate Bill 2397 will take place on Thursday, with amendments due by 1 pm on Tuesday. Additionally, the Joint Committee on Financial Services will hold a hearing on Thursday where it will hear testimony on House Bill 1062, an act relative to transparent health care data. This bill as outlined revokes CHIA’s ability to charge fees for real-time access to payer and provider claim details; standardizes the content provided on the Consumer Health Information Website (comparative price and cost information for the most common referrals or prescribed services, patient decision aids); and requires carriers to share data with small group health insurance groups so that they can better control their costs.
House and Senate leaders continue to debate a compromise supplemental budget, which includes language, in both House and Senate versions, to extend the sunset on co-pay assistance.