Continuing off their success at capping out-of-pocket insulin costs, Sen. Andy Manar, D-Bunker Hill, and Rep. Will Guzzardi, D-Chicago, said the next solution in lowering drug prices is determining which medications should be subject to price limits.
House Bill 3493 would create the Prescription Drug Affordability Board, comprised of healthcare economy and medicine experts, to research which drugs are causing affordability issues and decide on setting upper payment limits on them.
Individual providers already set their own upper payment limits when negotiating with drug manufacturers to purchase drugs, but HB3493 would set a single limit for every payer in the state, Guzzardi said.
“If you’re a drug manufacturer and you want to sell into Illinois – you can set whatever price you want, this is not a price control – but it says payers in Illinois will only pay X-dollars for it, so if you want to sell here, you would be wise to sell for less than that amount for these payers,” Guzzardi said.
The bill doesn’t limit which medications the board can research and Manar said “it would be hard to parse out one particular drug.”
The Prescription Drug Affordability Stakeholder Council would also be created. It would be made of 21 members representing all parties involved such as brand name and generic drug corporations, pharmacy benefit managers, pharmacists, health insurers, hospitals, doctors, healthcare advocates and more.
The 21-member council would give stakeholder input to the board. Guzzardi and Manar noted the importance of the board gathering and weighing all stakeholder information to make decisions on which drugs should have upper payment limits.
Guzzardi and Manar noted that the board should be able to gather and weigh all stakeholder information to make a decision on which drugs should have an upper payment limit.
The Pharmaceutical Research and Manufacturers of America said HB3493 is the wrong approach because it could limit access to treatments and it fails to address the “long line of middlemen in the pharmaceutical supply chain that impact what patients pay.”
“One of the best ways to lower out-of-pocket costs is to make sure patients get their share of the rebates and discounts that biopharmaceutical companies already provide,” PhRMA public affairs director Tiffany Haverly stated.
A recent statewide survey found that about half of Illinoisans have faced cost-related barriers like delaying or avoiding doctor visits and procedures, skipping prescriptions or cutting pills. Protect Our Care Illinois, a healthcare advocacy group, surveyed over 1,000 residents last month.
One person affected is Graciela Guzman, who was diagnosed with endometriosis and arthritis over 10 years ago and never thought she would deal with high medication costs.
She found out last month that one of her prescriptions increased from $68 to $500 while buying it at the counter. She had to decide in that moment whether to pay one of the bills that month or forgo the prescription altogether, Guzman said.
“I ended up cutting my pills instead,” Guzman said. “I got through work with heating pads. I cancelled on my friends, my family and my work obligations because I just wasn’t well enough to be able to attend basic things that I wanted to do. Medications can’t work for me if I can’t afford them, period.”
Manar said stories like Guzman’s happen across the state and that the bill is a step in the right direction.
“(HB3493) applies a very reasonable check and balance on a system that is completely out of control because of the lack of action by both the federal government and our state government in past years,” Manar said.
Survey results also found 81% of residents are worried about affording healthcare in the future and when asked what issues the government needs to address, the highest response was healthcare at 64%.
Guzzardi also said that 90% of Democrats and 80% of Republicans favor a board regulating the cost increases, but also noted there are no Republican lawmakers co-sponsoring the bill.
“I’ve been frustrated so far that my Republican colleagues haven’t seen fit to join us in this effort,” Guzzardi said. “Their constituents are hurting just as much as mine are, if not more so, but I’m optimistic that we’ll have a good discussion in committee and hopefully bring some of those folks along.”
Contact Kade Heather: [email protected], 782-3095, twitter.com/kade_heather
