State Lawmakers to Tackle High Prescription Drug Costs

Published in the Woonsocket Call on February 16, 2020

The Washington, DC-based AARP began its call for reducing prescription drug prices nationally in the late spring of 2019. At the same time, state legislatures around the country began taking up legislation. However, in Rhode Island, where the legislature meets only once a year, from January to June, it was too late to introduce bill in last year’s session.

AARP’s Elaine Ryan, VP of State Advocacy and Strategy reports: “We’re seeing an unprecedented number of states tackling the problem of high prescription drug prices. About 45 states expect to engage on prescription drug legislation or regulations this year. Right now, AARP is actively engaged in legislation in 25 states to address rising prescription drug prices. A variety of bills are moving through state legislatures, including bills on cost-sharing caps on insulin, price transparency, importation, price gouging, and affordability boards.”

Now, AARP Rhode Island is gearing up its lobbying efforts on Smith Hill this legislative session to put the brakes on rising prescription drug costs.

High Prescription Costs Top AARP Rhode Island’s Issues

State Director Kathleen Connell, of AARP Rhode Island, led the charge against skyrocketing drug costs by taking the group’s “Stop Rx Greed: Cut Drug Prices Now” campaign to four Rhode Island communities. At its AARP RI Community Conversations kickoff event in Warwick on Oct. 15, she called on Congress and the Rhode Island General Assembly to make prescription drugs more affordable a legislative priority. “We pay not only at the pharmacy counter, but through higher insurance premiums, and through the higher taxes we need to pay to fund programs like Medicare and Medicaid. Older Americans are hit especially hard. Medicare Part D enrollees take an average of 4 to 5 prescriptions per month, and their average annual income is around $26,000. One in three Americans has not taken a medication as prescribed because of the cost,” she said.

Connell reported that a recent AARP Rhode Island’s survey revealed that 79 percent of the member respondents called for lowering the price of prescription drugs, considering it the organization’s top priority.

During these events, using state-by-state specific data released last summer by AARP researchers, Connell was able to use Rhode Island data to document an increase in drug costs for seniors, identifying these drugs, the number of Rhode Islanders who need them and how much costs have risen.

Rhode Island’s state specific data revealed that the average annual cost of brand name prescription drug treatment increased 58 percent between 2012 and 2017, while the annual income for Rhode Island increased only 5.6 percent. Prescription drugs don’t work if patients can’t afford them, says the aging advocacy group, says Connell.

AARP Rhode Island also held Community Conversations in North Providence (Oct. 29), East Providence (Nov. 21) and Newport (Dec. 5). About 80 people attended these events, including in the legislative districts in those communities, along with Senate President Dominick J. Ruggerio (D-District 4, North Providence, Providence) and House Majority Leader Joseph Shekarchi (D-District 23, Warwick).

AARP Rhode Island Calls for Lower Prescription Drug Costs

On Feb. 5, over 120 people, including state lawmakers, Secretary of State Nellie M. Gorbea, and AARP Rhode Island staff and members, gathered in the State Room to attend the AARP Rhode Island Annual Reception. The event would become the backdrop to announce the Rhode Island Senate’s legislative agenda to tackle increasing prescription drug costs, the unveiling of package of eight bills supported by AARP Rhode Island.

At the event, Connell said: “This is an issue we are pounding on and I think you are going to see progress this year on this stellar important issue – Stop Rx Greed. I don’t need to go through the list of hardships suffered as these prices escalate way beyond reason. And we know this can’t continue the way it is. It’s probably not going to be a silver bullet that will solves this, but a lot of lot more work of the kind you have seen to make this iceberg move.”

Senate President Ruggerio along with 14 Senators from his chamber came to announce their support of the AARP sponsored legislation that would provide a pathway to import less-costly drugs from Canada, increase more market transparency, raise senior’s awareness around price changes and limit patients’ share of the costs.

House Majority Leader Shekarchi, came to the legislative reception with 20 House lawmakers, to share their concern about the lack of affordability of prescription. Shekarchi personally knows about high drug costs. “I am a Type II Diabetic and I have a lot of prescriptions. I feel the pain because I pay $30 a pill with the copay. I know what it costs and it is ridiculous,” he says.

“Patients deserve to know what drugs will cost, how they can pay for them in a fair and reasonable way, and how they can take advantage of any or all opportunities to save on those costs,” said Shekarchi, stressing that “people living on fixed incomes should not have to skimp between doing what is essential in buying prescription drugs, or food or housing.”

Shekarchi noted that he has already put in legislation with House colleagues, calling for Rhode Island’s insurers to completely cover the cost of copays for epinephrine injectors, or EpiPens. The bill would help reduce the high cost of the injectors, which has prevented some people with allergies from obtaining the life-saving device. The Warwick lawmaker also cosponsored a bill to create a prescription drug affordability board to protect Rhode Islanders from the high costs of prescription drug products.

Shekarchi concluded, by announcing that House lawmakers will shortly join the Senate in introducing AARP’s package of legislation (from five up to eight bills).

In a statement announcing the introduction of Senate bills to lower prescription drug costs, Ruggerio said: “Rhode Island’s population is one of the oldest in the nation, and the high prices consumers pay for prescriptions have a significant impact on us. Most older Rhode Islanders have limited means, and the high costs mean many people are cutting back on essentials of living or taking less than their prescribed amount of expensive drugs. The pharmaceutical industry is not going to address this on its own, so it’s up to the state and federal governments to take action.”

Tackling the High Cost of Prescription Drugs

After AARP Rhode Island’s Annual Legislative Reception, the following legislative proposals were thrown into the legislative hopper that day and companion measures have now been introduced in the House.

Senate legislative proposals included:

A bill limiting changes to a health plan’s drug formulary — its list of covered drugs — to protect consumers. Sponsored by Sen. Elizabeth A. Crowley (D-District 16, Central Falls, Pawtucket), this legislation (S 2324) would generally limit plans to modifying formularies at renewal time with 60 days’ notice and require that modification be identical among all substantially identical benefit plans.

Legislation (S 2319) sponsored by Senate Majority Leader Michael J. McCaffrey (D-District 29, Warwick) to cap out-of-pocket expenses for prescription drugs at the federal limits for high-deductible health plans, currently $1,400 for individual plans and $2,800 for family plans.

A bill (S 2317) sponsored by Senate Majority Whip Maryellen Goodwin (D-District 1, Providence) to prohibit cost sharing for patients 45 or older for colorectal screening examinations, laboratory tests and colonoscopies covered by health insurance policies or plans.

Legislation (S 2322) sponsored by Sen. Melissa A. Murray (D-District 24, Woonsocket, North Smithfield) to limit the copay for prescription insulin to $50 for a 30-day supply for health plans that provide coverage for insulin.

A bill sponsored by Sen. Walter S. Felag Jr. (D-District 10, Warren, Bristol, Tiverton) requiring pharmacists to advise patients about less-expensive generic alternatives to their prescriptions or when it would cost them less to pay for their drugs outright instead of using their insurance. The bill (S 2323) would also bar pharmacy benefits managers from imposing gag orders on pharmacists that prevent them from making such disclosures.

A prescription drug transparency act (S 2318), sponsored by Senate President Ruggerio. This bill would requires pharmaceutical drug manufacturers to provide wholesale drug acquisition cost information to the Department of Health and pharmacy benefit managers to provide information related to drug prices, rebates, fees and drug sales to the health insurance commissioner annually. Such transparency would help payers determine whether high prescription costs are justified.

A bill (S 2321) sponsored by Sen. Louis P. DiPalma (D-District 12, Middletown, Little Compton, Tiverton, Newport) to create a state-administered program to import wholesale prescription drugs from Canada, which has drug safety regulations similar to those of the United States. Such programs are allowed under federal law, with approval from the U.S. Food and Drug Administration.

Legislation (S 2320) sponsored by Sen. Cynthia A. Coyne (D-District 32, Barrington, Bristol, East Providence) to create a prescription drug affordability board tasked with investigating and comprehensively evaluating drug prices for Rhode Islanders and possible ways to reduce them to make them more affordable.

As the 2020 Presidential election looms, Congress and state law makers are very aware that lowering skyrocketing prescription drug costs is a top priority for their older constituents. With more than 250 bills passed by the Democrats in the House (some of these bills would lower prescription drug costs) sitting in Senate Majority Leader Mitch McConnell’s “legislative graveyard,” the Rhode Island General Assembly must take the lead to legislatively fix the problem.

Connell anticipates that there might be more than 15 drug bills in the House and Senate, 10 submitted by AARP. Rhode Island lawmakers must seriously consider these legislative proposals and join the 26 states that have already passed new laws aimed at lowering prices for prescription medications.

Bills Passed to Assist Rhode Island’s Seniors, Disabled

Printed in the Woonsocket Call on July 7, 2019

With the dust settling after the adjournment of the Rhode Island General Assembly’s 2019 legislative session on June 30, 2019, Rhode Island Governor Gina Raimondo halfheartedly signed the state’s 2020 fiscal year $9.9 billion budget into law.

The newly enacted budget closes a $100 million budget gap while avoiding new taxes for businesses, fully funding the state’s education aid formula, continuing to phase-out the car-tax, maintaining fiscal support for municipalities. And, State lawmakers did not forget older Rhode Islanders and disabled persons, putting tax dollars into programs assisting them.

Included in the state budget signed by Raimondo is $499,397 to fund the Rhode Island Livable Home Modification Grant Act that was introduced by Rep. Joseph M. McNamara, D-Warwick, Cranston and Sen. Walter S. Felag Jr., D -Bristol, Tiverton, Warren.

The grant allows eligible homeowners and renters to retrofit their residence to nationally recognized accessibility standards and receive 50 percent of the total sum spent, up to $5,000, to retrofit their existing residence.

The intent of this state program is to assist older Rhode Islanders and disabled persons to stay safely in their homes longer rather than being admitted to costly nursing homes, which costs taxpayers millions of dollars each year in Medicaid costs. With the graying of state’s population, there is a need for housing that is safe and adapted to the needs of their older occupants. (The Livable Home Modification Grant Application and Post-Retrofit Claim form can be found at http://www.gcd.ri.gov.)

Meanwhile, aging advocates gave the thumbs-up to Rhode Island lawmakers who eliminated a sunset provision in the state budget for a program that provides fare-free bus passes to low-income seniors and elderly Rhode Islanders, making this program permanent.

Awaiting the Governor’s Signature

The General Assembly passed legislation (S 0691A, H 6219), introduced by Senator Frank S. Lombardi, D-Cranston and Rep. Evan P. Shanley, D-Warwick, that would help caregivers to build onto their houses to provide space for relatives. The measure now moves to the governor’s office for consideration.

The passed legislation expands the definition of “family member” for purposes of zoning ordinances to include child, parent, spouse, mother-in-law, father-in-law, grandparents, grandchildren, domestic partner, sibling, care recipient or member of the household.

Under the legislation, the appearance of the home would remain that of a single-family residence with an internal means of egress between the home and the accessory family dwelling unit. If possible, no additional exterior entrances would be added. Where additional entrance is required, placement would generally be in the rear or side of the structure.

This legislative session, State lawmakers also approved legislation sponsored by Sen. Adam J. Satchell D- West Warwick and Rep. Robert E. Craven, D- North Kingstown, to establish a formal process recognizing “supported decision making,” a structure of support for disabled or aging individuals.

The legislation, which now heads to the governor’s desk, establishes a system of personal support that is less restrictive than guardianship to help individuals maintain independence while receiving assistance in making and communicating important life decisions. It is aimed at providing an alternative with more self-determination for individuals who are aging or who have developmental or intellectual disabilities.

Under the bill (2019-S 0031A, 2019- H5909), Rhode Islanders would be able to designate another person, or a team of people, as a supporter who would help them gather and weigh information, options, responsibilities and consequences of their life decisions about their personal affairs, support services, medical or psychological treatment, education and more. The supporter would also help the individual communicate the person’s wishes to those who need to know.

The legislation creates a legal form that establishes the agreement between individuals and their supporters, and designates the types of decisions with which the supporter is authorized to help. The bill establishes that decisions made with support under such an agreement are legally valid, and allows supporters to assist with the accessing of an individual’s confidential health and educational records.

It also requires that any other person who is aware that an individual is being abused, neglected or exploited by their supporter is obligated to report that abuse to the proper authorities.

Protecting Rhode Island’s Seniors and Disabled from Financial Exploitation

Sen. Valarie J. Lawson, D-East Providence and Rep. Joe Serodio’s D-East Providence, legislation (2019-0433A, 2019-H 6091A), “Senior Savings Protection Act,” was passed by the General Assembly and now heads to the Governor’s desk for signature.

The act would require certain individuals to report the occurrence or suspected occurrence of financial exploitation of persons who are age 60 and over or those with a disability between the ages of 18 and 59 years old.

According to the legislation, if a qualified individual, a person associated with a broker-dealer who serves in a supervisory, compliance or legal capacity, believes that financial exploitation is taking place, or being attempted, the individual must notify Rhode Island’s Department of Business Regulation and Division of Elderly Affairs, and law enforcement. The individual may also alert immediate family members, legal guardians, conservators, or agents under a power of attorney of the person possibly being financially exploited.

The legislation also calls for the Department of business Regulation and the Division of Elderly Affairs to develop websites that include training resources to assist in the prevention and detection of financial exploitation against Rhode Island’s seniors and disabled.

Combating Alzheimer’s Disease

With the number of persons with Alzheimer’s Disease expected to increase in the coming years, the General Assembly approved bills to better support Rhode Islanders affected by debilitating mental disorder and to protect against elder abuse. There are an estimated 23,000 Rhode Islanders age 65 and older living with Alzheimer’s disease. In just six years, the number is expected to increase to 27,000.

The Rhode Island General Assembly approved legislation (S 20223, 2019-H 5178) sponsored Sen. Cynthia A.Coyne, D-Barrington, Bristol, East Providence, and House Majority Leader K. Joseph Shekarchi, D-Warwick, to establish a program within the Department of Health dedicated to Alzheimer’s disease, and create a 13-member advisory council that would provide policy recommendations, evaluate state-funded efforts for care and research and provide guidance to state officials on advancements in treatment, prevention and diagnosis. The bill is based on legislation signed into law last year in Massachusetts.

The legislation requires the Department of Health to assess all state programs related to Alzheimer’s, and maintain and annually update the state’s plan for Alzheimer’s disease. It would also require the Department of Health to establish an Alzheimer’s disease assessment protocol specifically focused on recognizing the signs and symptoms of cognitive impairments, and appropriate resource information for effective medical screening, investigation and service planning. The legislation would also require caseworkers working with the Department of Elderly Affairs to become familiar with those protocols. Additionally, the legislation would require a one-time, hourlong training on diagnosis, treatment and care of patients with cognitive impairments for all physicians and nurses licensed in the state.

Most importantly, adoption of the legislation would enable Rhode Island to qualify for federal funding that is available to help states with their efforts to support those with Alzheimer’s disease.

Also gaining final Rhode Island General Assembly approval was legislation (2019-S 0302A, 2019-H 5141) sponsored by Sen. Coyne and Rep. Joseph M. McNamara, D-Warwick, Cranston, to allow the spouses or partners of patients residing in Alzheimer’s or dementia special care unit or program to live with them, even if they do not meet the requirements as patients-themselves.

Finally, Sen. Coyne, who lead the Senate’s Special Task Force to Study Elderly Abuse and Financial Exploitation, successfully spearheaded an effort this session to pass legislative proposals to beef up the state’s efforts to combat elder abuse, that is growing and vastly under reported. For details, go to herbweiss.wordpress.com, to access the June 30 commentary, “Senate Task Force Calls for Action to Combat State’s Growing Elder Abuse.”

Religious Groups Urge House to Combat Antisemitism and Racism

Published in the Woonsocket Call on June 10, 2019

For the second year in a row, the Rhode Island General Assembly’s Senate Judiciary Committee heard a resolution, introduced by State Senator Donna Nesselbush (Democrat, District 15, Pawtucket), calling on lawmakers to denounce and oppose white nationalist and neo-Nazi groups. The resolution was co-sponsored by Senators Samuel Bell (Democrat, District 5, Providence), Joshua Miller (Democrat, District 28, Cranston), Gayle Goldin (Democrat, District 3, Providence) and Ana Quezada (Democrat, District 2, Providence),

The initial resolution, introduced in 2017, urged state police to consider White Nationalists and Neo Nazi groups as terrorists. Because of First Amendment concerns expressed by the American Civil Liberties Union of Rhode Island that resolution was held for further study, and the language was reworked this run so as not to run afoul of free speech concerns.

Senate Moves to Fight Antisemitism and Racial Intolerance Head On

At the May 30 hearing, Nesselbush (Democrat, District 15, Pawtucket) pushed for passage of S0829, a resolution calling on Rhode Island to “denounce and oppose and the totalitarian impulses, violent terrorism, xenophobic’ biases, and bigoted ideologies that are promoted by white nationalists and neo-Nazis.” She reminded the Senate panel that Rhode Island was founded on Roger William’s principles of religious tolerance, and the state should denounce any type of white supremacy or neo-Nazism and take a stand for religious freedom and tolerance.

Nesslebush’s Senate resolution unanimously passed in Senate Judiciary Committee and ultimately on the Senate Floor. With its passage, no further action is required and the resolution will be transmitted to the Secretary of State, who is charged in the resolution with transmitting certified copies of the resolution to President Donald J. Trump, the members of the Rhode Island Congressional delegation, and Governor Gina Raimondo.

When asked about a House companion resolution that denounces and opposes White Nationalists and Neo Nazi groups, Larry Berman, the House’s Director of Communication, says that Rep. Jean Philippe Barros (Democrat, District 59, Pawtucket) had planned to introduce one but “because it was getting late in the session” he was unable to get his bill introduced. It should be noted that Senate President Dominick J. Ruggerio allowed Nesselbush to introduce her Senate resolution recognizing its merit and importance to the Jewish community.

Calls for the House to Confront the Boldness of Hate Groups

As the House is poised to release its anticipated state budget, religious groups and supporters of Nesselbush’s resolution, call for the lower chamber to take a strong stand to denounce and oppose White Nationalists and Neo Nazi groups.

As President of the Board of Rabbis of Greater Rhode Island, being active and serving as Rabbi at Temple Beth-El, Rabbi Sarah Mack, says it’s not too late for the to take a stand against antisemitism. “As Jews, we fight against bigotry and extremism because as a people we have experienced the danger of hate firsthand. While it is important to focus on extremism in all of its forms, we appreciate this resolution that calls attention to white supremacists, neo-Nazis and their hateful agenda. Because of this, I am so thankful to the Senate for passing this resolution, and I beseech our House leadership to do the same.”

Adds Adam Greenman, President and CEO of the Jewish Alliance of Greater Rhode Island, “we are committed to combating hatred in all forms. This resolution would give our state the opportunity to stand up against groups that promote anti-Semitism, white supremacy and other forms of toxic and dangerous rhetoric. We ask those in the House of Representatives to join us in supporting this resolution.”

Rev. Dr. Donnie Anderson, Executive Minister, of the Rhode Island State Council of Churches, notes the importance for the House to support Nesslebush’s Senate resolution to fight hate. “In recent years hate speech has found a new platform in social media and is flourishing in the current political climate. This explosion of hate DEMANDS a response from our political leaders. Rhode Island is blessed with wonderful interfaith leaders who interact on a regular basis and have built an atmosphere of caring, respect and trust. This group consistently and often speaks against hate, but we need to hear from ALL of our political leaders. We urge passage of this timely and thoughtful resolution.”

Steve Ahlquist, a reporter at UpriseRI, a Rhode Island news web site covering progressive issues, testified in support of Nesselbush’s Senate resolution, gives his two cents about the importance of politicians combating hate groups. Ahlquist stressed, “Though this resolution is largely symbolic and does not have the force of law, it is important nonetheless that our elected officials ally themselves with Rhode Islanders most at risk of white supremacist violence. It has been documented by myself and others that these groups have twice come to our state to engage in violence, and have promised to return. Residents of Rhode Island need to know that our elected officials will have our backs when they are confronting these hate groups.”

“Our elected officials should be eager to repudiate white supremacy and neo-Nazism. There has been violence done and violence planned in Rhode Island by hate groups visiting our state. There has been and hate crimes at synagogues and mosques. The Senate passed a resolution with ease. It is truly the least we can expect from the House to follow suit,” says Ahlquist.

Rhode Island Religious Community Takes a Stand

For years, it has been reported that antisemitism is becoming firmly entrenched in the Ocean State. In 2017, the Providence Journal reported that the New England chapter of the Anti-Defamation League recorded 13 incidents of antisemitism in Rhode Island. Nazi swastikas were painted on a Providence building, at Broad Rock Middle School in North Kingstown, and even at a Pawtucket synagogue in Oakhill, just a five-minute walk from my house, reported Rhode Island’s largest daily.

When I testified for passage of Senate Resolution 0829, I told the Senators that I often wondered what I would have done if I stood on a street in Germany in 1938 seeing all those windows broken (during a two-day pogrom, referred to as Kristallnacht. Would I have the courage or the gumption to go up to somebody dressed in a brown shirt with a swastika armband and stop him from hitting an elderly Jew?
Hopefully yes, but who knows.

But, on May 30, 2019, at the Senate Judiciary Committee hearing, I sat beside Sen. Nesselbush and Steve Ahlquist as we “took a stand,” calling on the Committee to pass S 082. Knowing the wisdom in denouncing and opposing the hateful philosophy of white nationalist and neo-Nazi groups that is becoming all too common in Rhode Island, the Senate took its stand.

After all, Rhode Island was founded by Roger Williams on the principle of religious tolerance, and we’re the home of America’s oldest synagogue, the Touro Synagogue, in Newport. What does it say to the nation, and especially to the state’s Jewish, racial, ethnic, LGTBQ communities if the House does not take an opportunity to oppose and denounce hate in their own backyard?

Hopefully, House Speaker Nicholas Mattiello will reconsider allowing a resolution, with no fiscal cost, to be introduced to give House lawmakers, like their Senate colleagues, an opportunity to oppose white nationalists and neo-Nazi groups. It is important for both chambers to take a legislative stand to combat the rising incidence of antisemitism and racist incidents. The resolution serves the purpose of sending the message, hate groups who are planning to come to Rhode Island to cause violence are not welcome here.