Aims to promote transparency, patient access
The State Senate passed, 39-1, Thursday, Feb. 10, pharmaceutical legislation aimed at addressing the rapidly rising cost of prescription drugs and ensuring that lifesaving drugs are affordable, fairly priced and accessible to all consumers.
Senator Cindy F. Friedman (D-Arlington) played a leading role in crafting the legislation, called Pharmaceuticals Access, Cost and Transparency Act (PACT Act 2022), says a press release from his office.
“This legislation brings the Commonwealth closer to a system that delivers affordable, high-quality and accessible care to our residents,” said Friedman, Senate Chairman of the Joint Committee on Health Care Financing. “The PACT Act 2022 ensures that more consumers can access prescription drugs at a fair price, by capping direct insulin costs, relieving certain expensive drugs, improving patient access to drugs and to the pharmacies of their choice and improving transparency and oversight within the pharmaceutical industry.
“I thank President Spilka, President Rodrigues, my colleagues, and the many stakeholders who contributed to the development of this bill, and I hope that this bill will soon be enacted.”
Seeking to identify drugs
Too often, patients cannot access the medications they need due to high prescription drug prices. The PACT Act 2022 contains enhanced accountability tools to address this and other barriers to care, the press release said. Currently, Massachusetts cannot effectively identify drugs with high costs that prevent patients from being able to afford them.
These financial barriers also contribute to unresolved health issues and often worsen conditions. This legislation directs the Health Policy Commission (HPC), in consultation with stakeholders, to establish a process for identifying price thresholds for drugs that pose a risk to public health. In addition, it allows the CHP to recommend pricing measures to increase patient access to needed medicines. Drugmakers who do not comply with this process will be required to pay fees to be paid into a trust fund for a new drug cost assistance program to support patients with certain chronic diseases that affect disproportionately marginalized communities.
In a first for Massachusetts, the legislation provides immediate relief from the price of insulin, a life-sustaining daily medication for one in 10 Massachusetts residents with diabetes, without which they face risks and significant health complications. Insulin prices have recently risen sharply, resulting in costs of up to $1,000 or more per year for patients on high-deductible or underinsured plans. This financial burden often forces patients to engage in the dangerous practice of severely limiting or forgoing insulin use.
Permanent cap at $25
To address this issue, the 2022 PACT Act limits out-of-pocket spending on insulin by eliminating deductibles and coinsurance, and permanently capping copayments at $25 per 30-day supply. If this law2 is enacted, Massachusetts will join 21 other states that cap coinsurance for insulin.
An amendment passed by the Senate also directs the Center for Health Information and Analysis (CHIA), an independent state agency that provides objective analysis of Massachusetts’ health care system, to study the feasibility of requiring access to epinephrine injectors for children free of out-of-pocket charges.
The bill brings oversight to pharmacy benefit managers, who play a major role in how drugs are prioritized and priced on insurance plans. These handlers serve as brokers or “middlemen” in the drug transaction process and are not currently subject to rigorous state oversight, making it unclear whether the handlers are acting in the best possible way. interest of consumers or health plans when negotiating drug prices. with pharmaceutical manufacturers. The PACT Act 2022 empowers the Division of Insurance to provide much-needed oversight by licensing and regulating these managers and establishing penalties for those who fail to meet certain standards.
To ensure that patients pay the lowest possible cost over the counter at the pharmacy, the PACT Act 2022 relies on federal legislation to ensure that a patient who purchases a prescription drug is not charged a split amount costs, such as a co-payment or deductible, that exceeds the retail price of the drug.
Eyes helping the pharmacy of choice
The bill also takes important steps to ensure that patients can get their prescription drugs from the pharmacy of their choice. This bill will allow any pharmacy to obtain a license to dispense specialty drugs and to contract with insurance plans to provide specialty drugs to patients. Additionally, this bill provides patients with greater access to mail-order prescriptions by allowing any network pharmacy to contract with carriers to provide mail-order prescriptions, changing the current practice of carriers determining which pharmacies are available to patients for mail-order prescriptions.
“Our HelpLine takes calls from people across the state who cannot afford their medications. Individuals and families in Massachusetts have struggled for far too long to access and pay for the prescriptions they need, and this legislation provides critical financial relief at a pivotal time,” said Amy Rosenthal, executive director of Health Care For All. “By passing this bill today, senators have taken an important step to curb excessive drug costs, aligning the oversight of pharmaceutical companies and pharmacy benefit managers with other healthcare industries across the country. State.”
Satisfied Pharmacy Group Leader
“As a representative of the largest number of independent pharmacies in Massachusetts, we are thrilled with the Senate’s action today to pass comprehensive legislation to address rising prescription drug costs and patient access to their local pharmacy,” said Todd Brown, executive director. of the Independent Pharmacists Association of Massachusetts. “This legislation is a major step forward in protecting patients from rising prescription drug costs and barriers to care resulting from what has long been a black box of secrets by the Pharmacy Benefit Management (PBM) industry. ). We are encouraged to see that many of our concerns about unfair PBM practices have been incorporated into this bill and support the emphasis on transparency and accountability, which are positive developments for patients and independent pharmacies. from Massachusetts.
To help further control costs, the PACT Act 2022 requires pharmaceutical manufacturers to notify the state in advance of new drugs coming to market and of significant price increases for existing drugs. With advance notification, the state’s MassHealth program can better prepare for potential cost increases by exploring ways to mitigate costs or negotiating improved pricing.
In addition, advance notification will allow the HPC to focus on these cost drivers during its Cost Trends Hearings, which are held annually to review healthcare cost drivers, identify challenges and opportunities for improve care and reduce costs in Massachusetts, increase transparency and accountability for health care providers and insurers, and help the state meet its annual health care cost growth goal.
Range of information collected
This bill also empowers CHIA to collect a range of drug cost information from pharmaceutical manufacturers and PBMs for inclusion in its annual health care cost report, which currently does not include comprehensive data. on drug costs. Collecting this data will allow policy makers and consumers to better understand the role of pharmaceutical manufacturers in driving up costs.
An amendment passed on the floor would ask the Department of Public Health, in consultation with the Attorney General, to analyze the rules of the Commonwealth Code of Conduct for Pharmaceutical and Medical Device Manufacturers to ensure they do not unduly influence prescribing patterns for opioids and other medications. .
The Senate has been a leader in proposing policies that address unaffordable drug costs. The Health Act, passed by the Senate in 2017, proposed policies to incorporate pharmaceutical costs into the state’s annual health care cost oversight process and ensure consumers are offered the lowest prices. lower available at the pharmacy. The Senate also defended including provisions in the fiscal year 2020 budget to allow MassHealth to directly negotiate additional drug discounts to save the state millions of dollars each year. The Senate adopted the first version of the PACT law during the 2019-2020 session. The PACT 2022 Act takes several important steps to contain drug costs and improve patient access throughout the healthcare system.
The PACT Act 2022 has been submitted to the State House of Representatives for consideration.
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This ad was posted on Sunday, February 13, 2022.