Rarely in our history has the power of science and innovation to keep our communities safe and healthy been in such clear focus.
And while vaccines have been grabbing headlines, for those of us in public health, we know that access to preventative treatments and medications is the best way to keep our population healthy and living full, productive lives.
However, far too often costs can be a significant barrier for patients when they go to the pharmacy to pick up their prescription medications.
Many solutions to this perennial problem have been proposed in recent years, both here in Connecticut and at the federal level. March kicked off with yet another legislative debate among Connecticut policymakers on the issue of healthcare costs.
Some proposals, though well intended, could have negative impacts on the very research and innovation aimed at developing new treatment options for patients.
Connecticut lawmakers should work to pass legislation that will actually put money back in the pockets of patients —where it was always intended to be, not penalize one facet of the healthcare industry, namely the biopharmaceutical industry. BioCT offered testimony in opposition to SB13, the Governor’s prescription drug proposal.
Most Connecticut residents probably don’t realize the complicated chain of negotiations and back and forth that results in being able to pick up your prescription medicine at the pharmacy counter. They’re also likely not aware that these negotiations result in big discounts being given to insurance companies and Pharmacy Benefit Managers (PBMs) that end up as profits for those companies, not savings for the patient.
Manufacturers negotiate with insurance companies and the insurer’s pharmacy benefit managers in order to get medications on the insurer’s prescription drug formulary, or preferred drug list—so the insurer pays less for the medication. However, when the insurer or PBM then sets the cost of what a patient pays out of pocket for their prescription, they can base it on the ORIGINAL HIGHER price, meaning a patient potentially pays more than intended in the granting of the discount.
Those extra dollars that the patient is paying means big bucks for the PBMs. A study by the Berkley Research Group found that in 2020, non-manufacturer stakeholders (insurers, PBMs, hospitals, governments) for the first time received the majority of spending on brand medicines.
Studies also show that commercially insured patients are often and unknowingly paying significantly more for medication than their insurance company. Estimates show that one in five brand name prescription cost sharing is based on the original list price.
Getting those savings back in the pockets of patients is one meaningful step forward in cutting prescription drug costs for patients and Connecticut lawmakers should follow the lead of other states who are enacting such reforms.
Last year, West Virginia passed legislation that requires the PBMs to pass a significant portion of the discounted price they pay drug manufacturers to be given to the patient at the prescription point of sale.
Without similar reform here in Connecticut, there will be no such opportunity for savings for patients.
We urge the Connecticut legislature and Gov. Ned Lamont to take a long hard look at the drivers of prescription drug costs and enact laws that work to address true affordability for patients.
Dawn Hocevar is President and CEO of BioCT.