Prescription drugs

As someone who has battled for years to secure insurance coverage for essential treatments, I have experienced firsthand the devastating impact of soaring health care costs on patients. Like many others, I have faced the burden of out-of-pocket expenses — such as copays and coinsurance — that arise from a health care system that favors corporate interests over patient care.

Prescription drug affordability boards (PDABs) were created to limit medication prices, but they often prioritize state savings over patient needs, potentially restricting access to critical medications.

Currently, eleven states have PDABs, with some allowed to set upper payment limits (UPLs). However, these boards face challenges and may inadvertently limit patient access to essential treatments.

The pharmaceutical supply chain is intricate, involving a network of doctors, hospitals, pharmacies, insurers, governments, and — most critically — patients. A change in any segment of this system can impact the others. The implementation of UPLs may create financial disincentives for providers to stock certain medications, potentially denying patients access to essential treatments.

Our very own Oregon PDAB at a meeting on June 26th, “paused” its work for six months to address a fundamental question: “How do you define what ‘affordability’ is?” If a board tasked with controlling drug prices cannot even define affordability, how can it help patients?

In Colorado, the PDAB found that two of the first three drugs targeted for price controls were considered “not unaffordable” for patients. One was a cystic fibrosis therapy costing $234,000 annually, but patients with commercial insurance paid only 3.59% of that cost. The second drug, for HIV/AIDS, had a monthly cost of $2,683, with about half of the patients paying $50 or less.

Maryland, the first state to create a PDAB, excluded a common HIV/AIDS treatment from its target list, noting existing assistance programs for low-income patients. PDABs nationwide are realizing that affordability includes out-of-pocket costs for patients. People in Oregon understand that timely access to the right treatment can transform lives. The question arises: Why do these unelected and unregulated boards neglect patient access and affordability in their decisions?

Patients are increasingly critical of PDABs due to concerns about losing access to medications. While government price-setting might seem beneficial, it often leads to fewer choices. More effective solutions could involve capping out-of-pocket expenses, prohibiting copay accumulators and ensuring pharmacy benefit managers pass discounts to consumers.

This concern is evident in Virginia, where the governor vetoed a PDAB bill in April, and in Maryland and Washington, where lawmakers have been cautious about expanding PDAB authority. There are more effective strategies to lower out-of-pocket expenses for patients. The Inflation Reduction Act is set to cap annual Medicare costs at $2,000 starting in 2025.

Additionally, states could establish their own limits on out-of-pocket expenses. The federal government could also prohibit copay accumulators, which hinder patients from using coupons to decrease their costs. Furthermore, pharmacy benefit managers could be mandated to pass discounts directly to consumers.

Despite their good intentions, PDABs are not the answer. It is crucial for patients to unite and advocate for our representatives and existing PDABs to prioritize genuine solutions that reduce costs while maintaining access to the treatments we rely on.

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