This year, the Connecticut General Assembly has held public hearings on several legislative proposals that have the potential to put patients’ access to life-saving drugs at risk.
Perhaps the most egregious of these proposals is SB 8: An Act Concerning Drug Affordability, which includes policy proposals to establish a Prescription Drug Affordability Board (PDABs), drug importation from Canada and a 340B mandate.
Prescription Drug Affordability Boards allow government-appointed board members to make critical medical decisions on pricing and access to prescription drugs for Connecticut patients — without consulting medical providers or individual patient information. This legislation, while it may be well-intended, almost entirely neglects individual patient needs for the sake of potential cost savings to the state.
PDABs are a hot idea for states to enact right now, but there is no actual track record yet of success, or worse failure, yet, and the health and safety of Connecticut residents deserves better than blindly following other states.
For those with rare or complex diseases like cancer, the impact of PDAB actions could be devastating. The bureaucratic boards will force price-based decisions about which drugs to allow into the state without any medical knowledge of the affected patients.
Those with knowledge of the pharmaceutical industry understand that drugs do not follow one narrow path from the manufacturer to the patient, and the acquisition cost of the drug along that path does not track consistently beside the payment patterns. Treating providers often have to buy the drug themselves, and then bill for the drug only after it is administered or dispensed to the patient. The physician or pharmacist rarely has any flexibility in setting the price which they are paid — those are defined by the health plan, PBM, or other management entity. Provider drug acquisition costs are also not under their control.
By focusing on setting arbitrary price limits and restrictions on drugs that do not recognize the complexity of medical care, drug acquisition, and drug billing, legislative proponents run the risk of shutting down access to needed drugs for the very patients they purport to want to help. PDAB legislation could make drugs unaffordable to the pharmacies and physicians that provide them, forcing critical access health care providers to shut down, reducing patient access not just to drugs, but to medical care as well.
Advisory boards are not in the business of treating patients. There is no role for an advisory board in medical decision-making, especially one based solely on pricing goals or arbitrary cost limits for medicines for vulnerable patients. Fighting cancer and other complex medical disease is hard enough without being told that a state appointed entity has made decisions for non-medical reasons that ultimately dictate that your access to drugs or even physicians has been taken away.
Senate Bill 8 also creates a structure and plan for the state to allow drug importation from Canada. This also is an idea that many states are blindly endorsing. No one is actually paying attention to Canada — which has said repeatedly that even if a state manages to create an infrastructure to acquire drugs from Canada — Canada needs its drugs and will not risk the health needs of its population to allow mass exportation to the U.S.
Health Canada has announced that it does not support actions that could adversely affect the supply of prescription drugs in Canada and potentially raise the costs of prescription drugs for Canadians. “Bulk importation from Canada will not provide an effective solution to the problem of high drug prices in the U.S.” That position has been made clear to both federal and state officials in the United States.
Why would Connecticut even consider wasting precious time and money to build the massive inspection and certification oversight needed for drug importation (which offers no guarantees that the drugs will still not be risky and have safety issues for Connecticut residents) when the platform on which the whole idea is predicated is a non-starter from the perspective of Health Canada? Drug importation is a false premise, fraught with safety, quality, handling and certification risks. Connecticut does not want to go down that path, least of all waste their time when the intended source of drugs — Canada — has no intention of allowing such mass importation.
In addition to these troubling policies, Senate Bill 8 was amended out of committee to include policy mandating manufacturers provide heavily reduced drug prices to all 340B contracted entities. Congress created the 340B drug discount program in 1992 to help vulnerable and uninsured patients access prescription medicines at safety-net facilities. Today however, just 19% of 340B contract pharmacies in Connecticut are located in medically underserved areas. Nationally, the majority (61%) of 340B hospitals’ off-site clinics are located in different ZIP codes than the hospital they are affiliated with, and those clinics often are in wealthier and less diverse communities (Data obtained from HRSA 340B OPAIS search.) This means that 340B entities tend to be in wealthier communities instead of the indigent communities the program was meant to serve.
By requiring manufactures to ship drugs at steep discount to all contracting entities, this policy proposal from the state will only serve to drive drug prices up for everyone while exacerbating the access issue already present in the program. Connecticut patients with the most critical financial and medical needs, the patients that 340B was created to serve, will continue to be left behind and most will never see the savings manufacturers pass on to hospitals.
While I understand the concern that Gov. Ned Lamont and members of the Connecticut General Assembly have regarding the affordability of health care, and that proposed legislation is well-intended, the actual consequences of the creation and actions of any type of Prescription Drug Advisory Board (PDAB), 340B Mandate, or drug importation will likely have the opposite effect for both patients and those who deliver care to them in Connecticut.
I urge Connecticut legislators and voters to oppose any proposed legislation with language establishing drug importation, a 340B mandate, or a PDAB, including SB 8: An Act Concerning Drug Affordability.
Dawn Holcombe is Executive Director of the Connecticut Oncology Association.
