A Costly Cure: Lawmakers unite to bring down prescription prices

SALT LAKE CITY — Small steps. State lawmakers continue to preach that soaring prices of prescription drugs aren’t going away tomorrow, but they can be brought down in the not-too-distant-future with dogged tenacity.

Two Utah leaders, a Republican in Salt Lake City and a Democrat in Washington D.C., are hoping to achieve a collective goal through bi-partisan legislation and first-of-its-kind ideas.

A lifetime of interest

Representative Norm Thurston has an extensive background when it comes to researching and understanding the prescription drug market.

After attending BYU, he went on to Princeton University where he received both an MS and Ph.D. in Economics. He also served as Utah’s Director of the Office of Health Care Statistics until January 2020.

For him, understanding the factors that drive market prices for life-saving drugs has been a lifelong fascination.

“I’ve always been interested in trying to help make markets more efficient,” he explains. “If markets are more efficient that should bring prices down. Prescription drugs, in particular, is a problem area where markets are not very efficient and we do see prices that are a lot higher than they need to be.”

A new answer to an old problem

For Thurston, it was a busy session at the capitol. Most notably, he’s receiving praise for the passage of House Bill 207, Insulin Access Amendments. The bill creates a co-pay cap of $30 per month per prescription. It also sets up a bulk purchasing program that will bring down the price for state employees and those without insurance.

“The first state to do this was Colorado,” Thurston explains. “They just had a $100 blanket co-pay cap, per month, per patient. The problem with doing it that way is that there is no flexibility for insurance companies to be creative in their plan design.”

He notes the bill gives insurance companies four different pathways, essentially allowing them “to bring their best game” to the insurance commissioner and make their case.

H.B. 207, Insulin Access Amendments, passes its second reading in the Senate! pic.twitter.com/4vkil7Tark

— Norm Thurston (@NormThurston) March 10, 2020

Beyond the co-pay cap, a first-of-its-kind bulk-purchasing program will help bring down insulin prices for Utah families. According to Thurston, it’s a prime example of how creative solutions can answer complex health care problems.

“It’s a fabulous idea. After this bill goes into effect, everybody can always go to PEHP and obtain a discount card,” he says. “Instead of paying $350 for a vile of insulin, they should be paying something closer to $65 or $70.”

Fighting big pharma

Congressman Ben McAdams says he hears about the soaring price of prescription drugs more than any other issue.

“I was waiting to catch a flight from D.C. home to Utah,” he explains. “A gentleman came up to me and said I want to tell you my story. He said, I have a rare form of cancer [and] as long as I take my medication, the doctors tell me it’s manageable and I will not die from this cancer.”

The man went on to explain that if he ever lost his job, an all-too-real situation for millions of Americans right now, that he would have no way to pay for this medication.

“If I ever lost my job, this medication is about $20,000 a month,” McAdams says the man told him. “If I lost my job, it would be a death sentence.”

According to McAdams, this is just one example of a situation that thousands of families can relate to.

“I hear stories from Utahns every week about the high cost of prescription drugs, how they’re struggling to pay for life-saving drugs for themselves or a child,” he explains. “We have to do something about this.”

It’s unacceptable that Utahns suffer because they can’t afford their prescribed insulin. This week I voted for bipartisan bills to make drug pricing more transparent and I continue to support measures to lower prices. #utpol pic.twitter.com/fonlQwyi8V

— Rep. Ben McAdams (@RepBenMcAdams) October 31, 2019

While state lawmakers have been busy throughout the General Session passing a number of bills aimed at bringing down prescription prices, McAdams has been working to attack the problem at its core.

One example is the CREATES Act, which is intended to increase the competitiveness of generic pharmaceutical drugs.

“The CREATES Act is a bill that I jumped on,” he explains. “It looks like a piece of the puzzle. It streamlines bringing generic drugs to the market.”

Specifically, it aims to deny pharmaceutical companies extended periods of exclusivity where they get to dictate the market on a drug.

“What we see is some bad actions,” he said. “You’ll see some loopholes that some drug companies are exploiting to extend it out longer and to keep that period of exclusivity, so they can charge a higher price and keep generic competition out of the market.”

A period of exclusivity is typically between eight to twelve years. By law, when that period ends drug companies have to give that product out to a generic manufacturer.

“The CREATES Act will hold the feet to the fire of those pharmaceutical companies, that they have to play by those rules,” says McAdams.

Applauding efforts back home

While continuing the fight against big pharma in Washington, McAdams is keeping a close eye on the work being done back in Salt Lake.

He believes it’s encouraging to see so much progress being made to ensure that diabetics everywhere can stay safe.

“We have got to bring down the price of insulin,” he explains. “There’s legislation at the federal level that I’m supporting. The Insulin Price Reduction Act.”

He said the bill will give manufactures who participate in an incentive to bring their prescription prices down.

“This would basically say that their drugs would be covered by Medicare and Medicaid with no deductible if they will bring their prices down to the level that they were at in 2006,” said McAdams. “So you would see an immediate reduction in the cost of insulin.”

Click here to view additional coverage about the prices of prescription drugs in Utah.