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.

Report on Falls, Injuries Released

PUblished in Woonsocket Call on October 20, 2019

Last Wednesday morning in Dirksen Senate Office Building 562, the U.S. Special Committee on Aging held a hearing to put a spotlight on the economic consequences on falls and to explore ways to prevent and reduce falls and related injuries. At the one hour and 55-minute hearing, titled “Falls Prevention: National, State, and Local Level Solutions to Better Support Seniors,” its annual report, Falls Prevention: Solutions to Better Support Seniors, was released.

According to the Senate Aging Committee, falls are the leading cause of both fatal and nonfatal injuries among older adults that incur $50 billion annually in total medical costs. That number is expected to double to $100 billion by 2030, and the majority of these costs are borne by Medicare and Medicaid.

“Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences. In addition to the physical and emotional trauma of falls, the financial toll is staggering,” said Sen. Susan Collins (R-Maine), who chairs the Senate Aging Committee. “Now is the time, and now is our opportunity, to take action to prevent falls. Our bipartisan report includes key recommendations to take steps to reduce the risk of falls,” the Maine Senator noted in an Oct. 16 statement.

Pushing for Positive Change in Releasing Fall Report

“We must dispel our loved ones of the stigma associated with falling so that they can get the help they need to age in place – where they want to be – in their homes and communities,” said Sen. Robert P. Casey, Jr. (D-Pa.). “I am hopeful that our work over the past year will propel the research community to do more, get more dollars invested into supporting home modifications and encourage more older adults to be active,” said the Special Committee’s Ranking Member.

At the hearing, the Committee unveiled a comprehensive report that provides evidence-based recommendations on ways to reduce the risk of falling. The Committee received input from multiple federal agencies, including the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and the Food and Drug Administration. In addition, approximately 200 respondents representing falls prevention advocates, hospitals, community organizations, home health agencies, and others shared their expertise on this issue.

The 34-page Aging Committee’s report made recommendations as how to raise awareness about falls-related risks, prevention and recovery at the national, state and local levels. It suggested ways of improving screening and referrals for those at risk of falling so that individuals receive the preventive care necessary to avoid a fall or recover after one. It noted ways of targeting modifiable risk factors, including increasing the availability of resources for home safety evaluations and modifications, so that older adults can remain in their homes and communities. Finally, it called for reducing polypharmacy so that health care providers and patients are aware of any potential side effects that could contribute to a fall.

Increasing Medicare Funding for Bone Density Testing

In an opening statement, Collins noted that falls are often times attributed to uneven sidewalks or icy stairs, medications, medical reasons or muscle strength. But one key cause of falling is osteoporosis, which can be especially dangerous for people who are completely unaware that they suffer from low bone density, she says.

According to Collins, although Medicare covers bone density testing, reimbursement rates have been slashed by 70 percent since 2006, resulting in 2.3 million fewer women being tested. “As a result, it is estimated that more than 40,000 additional hip fractures occur each year, which results in nearly 10,000 additional deaths,” she said, noting legislation, Increasing Access to Osteoporosis Testing Beneficiaries Act that she has introduced with Sen. Ben Cardin,” to reverse these harmful reimbursement cuts.

Casey stated, “I am particularly interested in sharing this report with the relevant agencies and learning how the recommendations will be implemented. Not just put in a report. Implemented,” adds Casey.

Peggy Haynes, MPA, Senior Director, of Portland-based Healthy Aging, MaineHealth that offers A Matter of Balance, an evidence-based falls prevention program, came to the Senate hearing to share details about its impact. “The health care community has a critical role to play in fall prevention – beginning with screening for falls, assessing fall risk factors, reviewing medications and referring to both medical and community-based fall prevention interventions. Our health system is focused on preventing falls in every care setting,” says Haynes.

“The need for a range of community-based options led MaineHealth to be a founding member of the Evidence Based Leadership Collaborative, promoting the increased delivery of multiple evidence-based programs that improve the health and well-being of diverse populations,” adds Haynes.

Haynes noted that older participants attend eight two-hour sessions to help them reduce their fear of falling, assisting them to set realistic goals for increasing their activity and changing their home environment to reduce fall risk factors. A Matter of Balance is offered in 46 states reaching nearly 100,000 seniors.

Virginia Demby, an 84-year-old visually-impaired retired nurse who is an advocate for Community and Older Adults, in Chester, Pennsylvania, came to the Senate hearing to support the importance of fall prevention programs. Despite living with low vision, Demby remains physically active by participating in exercises classes for older adults at the Center for the Blind and Visually Impaired in Chester. She is an advocate for older adults and now helps the local senior center wellness manager recruit more seniors to take falls prevention classes and find new places to offer the classes.

Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, of the Arlington, Virginia-based National Council on Aging, discussed the work of the National Falls Prevention Resource Center, which helps to support evidence-based falls prevention programs across the nation and highlighted policy solutions to reduce falls risk.

Finally, Elizabeth Thompson, chief executive officer, Arlington, Virginia-based National Osteoporosis Foundation, testified that bone loss and osteoporosis are fundamental underlying contributors to the worst consequences of falls among older Americans: broken and fractured bones. Osteoporotic fractures are responsible for more hospitalizations than heart attacks, strokes and breast cancer combined, she noted.

For details of the Senate Aging Committee report, go to http://www.aging.senate.gov/imo/media/doc/SCA_Falls_Report_2019.pdf.

Attacking Rising Prescription Drug Costs

Published in the Woonsocket Call on April 7, 2019

The Washington, DC-based AARP timed the release of its latest Rx Price Watch report as the House Energy Commerce Committee marked up and passed a dozen bills just days ago, six that would lower prescription drug costs. The legislative proposals now go to the House floor for consideration.

AARP’s new report, a continuation of a series that has been tracking price changes for widely used prescription drugs since 2004, was circulated to House Committee members before their markup and vote and its findings sent a message to the lawmakers that they hear from their older constituents, that is the costs of pharmaceutical drugs is skyrocketing, making it difficult to fill needed prescriptions.

Poll after poll findings reflect the concerns of seniors about their ability to pay for prescribed medications. According to a Kaiser Family Foundation poll released last month, 79 percent of survey respondents view drug prices to be “unreasonable,” while just 17 percent found the costs to be “reasonable.” Twenty-four percent of these respondents found it difficult to pay the costs of their prescription drugs.

Generic Drugs Can Save Dollars

According to the new AARP Public Policy Institute (PPI) report, by Leigh Purvis and Dr. Stephen W. Schondelmeyer, the average annual cost of therapy for one widely used brand-name prescription drug in 2017 was over 18 times higher than the cost of therapy for one generic drug. The cost for a generic medication used on a chronic basis averaged $365 per year. In contrast, the average annual cost for a brand-name prescription drug was $6,798. But, four years earlier the price differential between these same market baskets was substantially smaller ($4,308 verses $751 respectively).

“Generics account for nearly nine out of every 10 prescriptions filled in the U.S. but represent less than a quarter of the country’s drug spending,” said Debra Whitman, Executive Vice President and Chief Public Policy Officer at AARP, in a statement released with the PPI’s 28 page report “These results highlight the importance of eliminating anticompetitive behavior by brand-name drug companies so that we get more lower-priced generic drugs on the market,” says Whitman.

AARP’s PPI report, entitled “Trends in Retail Prices of Generic Prescription Drugs Widely Used by Older Americans,” found that retail prices for 390 generic prescription drugs commonly used by older adults, including Medicare beneficiaries, decreased by an average of 9.3 percent in 2017, compared to the general inflation rate of 2.1 percent. The decline follows two consecutive years of substantial generic drug price decreases; the previous two consecutive years saw increases in generic drug prices. All but three of the 390 generic prescription drugs analyzed in AARP’s report had a retail price change in 2017. While prices for 297 (76 percent) drug products decreased, 90 (23 percent) products had price increases.
Six commonly used generic drug products had retail price increases of greater than 70 percent, including a nearly 200 percent increase for sertraline HCL, an antidepressant, finds the AARP.

AARP’s PPI report found that with older adults taking an average of 4.5 prescription drugs every month, those using generic prescription drugs were likely to have an average annual retail cost of $1,642 in 2017.

“The gap between average annual brand-name and generic drug prices has increased dramatically—brand name drug prices were six times higher than generic drug prices in 2013 but more than 18 times higher in 2017,” said Leigh Purvis, Director of Health Services Research, AARP Policy Institute, and co-author of the report. “As long as brand name drug prices continue to skyrocket, the value of prohibiting brand name drug company practices that slow or prevent competition from generic and biosimilar drugs cannot be overstated.”

AARP Pushes for Passage of Bills to Lower Drug Costs

Before the Committee on Energy and Commerce vote on April 3, in correspondence AARP urged Chairman Frank Pallone, Jr. (D-N.J.) and Ranking Member Greg Walden (R-Ore) to enact two bills (along with four other proposals) being considered at the morning markup session. These legislative proposals would lower prescription drug costs and had previously been approved by the Energy and Commerce Health Subcommittee.

In the correspondence, AARP’s Nancy A. LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer, pushed for passage of H.R., 1499. the “Protecting Consumer Access to Generic Drugs Act of 2019.” introduced by Rep. Bobby Rush (D-IL). This proposal would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market. The bill was passed by voice vote.

LeaMond also supported H.R., 965, the “Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019,” introduced by Reps. David Cicilline (D-RI), Jim Sensenbrenner (R-WI), Jerrold Nadler (D-NY), Doug Collins (R-GA), Peter Welch (D-VT), and David McKinley (R-WV). The proposal would establish a process by which generic manufacturers could obtain sufficient quantities of brand drug samples for testing thereby deterring gaming of safety protocols that brand manufacturers use to delay or impede generic entry. The bill passed by a bipartisan vote of 51-0.

At the markup, Pallone and Walden were able to work out philosophical differences on H.R. 1499 and H.R. 965. The two lawmakers also hammered out a compromise on H.R. 1503, the “Organize Book Transparency Act of 2019,” that would ensure that the Orange book, which identifies drug products approved on the basis of safety and effectiveness by the Food and Drug Administration, is accurate and up-to-date.

Washington Insiders say that Democratic control of the House will ensure the passage of these legislative proposals on the House floor and the bipartisan vote on the CREATES Act in the lower chamber creates an opportunity for Senate Finance Committee Chairman Chuck Grassley (R-Iowa) to successfully push his CREATES Act companion measure in the Senate.

Grassley says the broad, bipartisan action by the House Energy and Commerce Committee to advance the CREATES Act is a major win for consumers. “I look forward to advancing this bill because it will cut down on abuses in the system that keep prices high for patients. I’m also pleased that the committee advanced a bill to address pay-for-delay schemes. Although that bill is not identical to the bill I’ve sponsored in the Senate, the bill’s movement shows that the committee is serious about addressing the pay-for-delay problem,” says the Senator.

As They See It…

AARP’s LeaMond, says “Brand-name drug companies want to stifle generic competition to protect their monopolies and profits. AARP believes that eliminating these deliberate anticompetitive behaviors will result in a more robust generic drug market and greater savings for both patients and taxpayers. The Congressional Budget Office estimated that legislation such as the CREATES Act could save taxpayers more than $3 billion over a decade, and the Federal Trade Commission estimated pay-for-delay deals cost consumers and taxpayers $3.5 billion a year.

“We have long supported the CREATES Act and banning pay-for-delay agreements, and are heartened that Congress is acting to improve access to generic drugs. These bills will promote competition driving down costs for seniors,” says Lisa Swirsky, Senior Policy Analyst, at the National Committee to Preserve Social Security and Medicare.

“Congressman Cicilline has been a leader in our caucus for putting prescription drug prices at the front of our agenda. Moving generics to market faster is an important step to lower prescription drug costs for every American,” said House Speaker Nancy Pelosi. “House Democrats have made it a top priority to lower Americans’ health costs by reducing the price of prescription drugs, and these bipartisan bills show we mean to deliver,” she says.