It’s tough to understand the reasoning behind lawmakers who on one hand are working every day to encourage residents to get vaccinated, to count on science to get the pandemic behind us, while on the same day calling for legislative proposals to gut the very system that enabled COVID vaccines to be developed and deployed in record time.
I’m not doubting that Governors Ned Lamont and Charlie Baker believe in the science that is getting COVID vaccines into the arms of millions of Americans each day. My colleagues and I want to work together with Governors Lamont and Baker to ensure that policies are enacted that help to lower cost of medications without impacting critical scientific innovation and the ability of science to discover cures for other diseases.
If our leaders really want to cut the cost of what residents pay for their prescription medications, the answer is far deeper than penalizing scientific research.
Now more than ever, as patient advocates, my colleagues and I are interested in solutions that will make prescription drugs affordable to the patient. These solutions must not only include pharmaceutical manufacturers but encompass all health care stakeholders, including insurance companies, wholesalers, pharmacy benefit managers, and others who restrict access to care and continuously shift costs onto patients.
A careful examination of drug pricing should be done through the lens of putting patient access and care first. Any legislative effort to address pricing needs to focus on making the health care system work better for patients. We want to make insurance work like insurance again. Solutions should focus on policies that lower out-of-pocket costs for patients while avoiding those that reduce patient access.
One such current legislative proposal – SB 1003 – introduced by the Insurance Committee, is a perfect example of legislation that would help lower out-of-pocket costs while preserving patient access. This legislation would prohibit health insurance companies and pharmacy benefit managers from employing copay accumulator programs. These programs place undue financial stress on patients while indirectly creating access barriers. Lawmakers like Senator Martin Looney and Representative Michelle Cook who have championed these types of proposals should be commended for taking steps to increase access to medications and address affordability challenges for patients.
Certainly, SB 1003 will not solve every patient’s challenges accessing and paying for their medications-but it’s a common-sense step in the right direction.
Patients’ out-of-pocket costs for prescription drugs in the form of high deductibles and coinsurance have continued to create critical access and affordability challenges for those with chronic conditions. Some legislative policy ideas that would help patients include: capping out of pocket cost that a patient pays, fixed co-pays across prescription drug tiers as opposed to insurers instituting co-insurance pricing, and better access to biosimilars –biologic medicines approved by the FDA as highly similar to the original biologic medicine that work in the same way and have no clinically meaningful difference in safety or efficacy.
Biosimilars have been approved for a wide range of conditions, including autoimmune diseases such as rheumatoid and psoriatic arthritis, and certain types of cancers.
Like generics for traditional medicines, biosimilars may offer lower-cost choices for patients who take biologic medicines. According to research by Pacific Research Institute, Connecticut could save as much as $76.2 million to over $116 million annually in healthcare savings, if biosimilars’ market share increased to 25% or up to 75% of the market, respectively. However, these savings have not been realized as formulary restrictions and the current rebate structure continue to be barriers. Improved access for biologics should translate into more affordable out-of-pocket costs for patients.
Recently, my colleagues and I penned a letter to Governor Lamont and other lawmakers sharing with them some of these ideas and reiterating our desire to lower health care costs for all residents of Connecticut. Discussions about the affordability of drugs are important, however, capping drug prices while failing to address affordability for patients could limit the ability of the deep bench of researchers and scientists that we have across Connecticut and the Northeast to continue to effectively do their jobs—finding cures at a time when we need it most.
Mike Finley is the executive director of the Epilepsy Foundation of Connecticut. Support for this op-ed was provided by members of our Directory of Political Professionals.
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