L.D. 1272 Testimony

TESTIMONY OF HANI JARAWAN, M.D.

IN SUPPORT OF

L.D. 1272, AN ACT TO INCREASE ACCESS TO LOW-COST PRESCRIPTION DRUGS;

L.D. 1387, AN ACT TO INCREASE ACCESS TO AFFORDABLE AND SAFE PRESCRIPTION DRUGS; AND

L.D. 1499, AN ACT TO ESTABLISH THE MAINE PRESCRIPTION DRUG AFFORDABILTIY BOARD

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Wednesday, April 17, 2019, 10:00 a.m.

Good morning Senator Sanborn, Representative Tepler, and Members of the Joint Standing Committee on Health Coverage, Insurance, & Financial Services.

My name is Hani Jarawan, M.D.  I am a general internist in Portland, specializing in adult inpatient hospital medicine.  I am a member of the MMA Board of Directors and Chair of the Maine Chapter of the American College of Physicians Health and Public Policy Committee.  I am here today on behalf of the MMA and Maine chapter of the ACP to speak in favor of the package of bills addressing prescription drug costs.

The 600 members of the Maine ACP are our state’s front-line medical providers, who care for Mainers in communities from Kittery to Caribou.  As primary care doctors, hospitalists, and related subspecialists, we diagnose, treat, and provide compassionate care for Mainers with everything from routine health needs to complex illnesses.  We play a critical role in preventing disease and promoting health and well-being.

The ACP, along with our partners at the MMA, supports consideration of a process to ensure the safe re-importation of drugs that you are discussing today.  I would refer you to background materials attached to my testimony on the details of the policies at hand.  I am here today to share my experience about the toll that the rising cost of drugs have on my patients, my colleagues, and my community.

The skyrocketing costs of prescription drugs is far from the only emergency affecting Maine medicine today, but it is so deeply intertwined in all the other crises that it may be the most important.

  • Every day, a 55 year-old woman from Waterboro comes to the emergency department with left-sided paralysis or crushing chest pain.  When I admit her, I learn that she has been cutting her insulin dose in half and skipping doses of her blood pressure medication because of cost.  She’s lucky enough to have insurance, otherwise her stroke or heart attack might have happened even earlier. The debility from these treatable diseases often means rehab stays, loss of independence, depression, lost wages, and significant strain on loved ones during recovery.  And of course, with these new complications come the need for new, often-expensive, but nonetheless life-sustaining medications.  Sadly, the crisis of metabolic syndrome, from which one third of Americans like her suffer, is worsened by patients being unable to afford their medications.
  • Americans are living longer. Maine’s aging population means that more of my patients are living with chronic kidney disease and congestive heart failure.  They are on active chemotherapy, and are taking blood thinners.  When a 68-year old chronically ill patient sees my colleague in the clinic for a simple skin infection, the antibiotic choice is medically challenging.  The liver and kidneys do not care what drugs are on his insurer’s formulary, yet prescription drug coverage policies can trump the risks of severe side effects.  If any one of the medications this patient needs is too expensive, there may be no other cocktail of drugs available to keep him healthy and prevent the next problem.

As doctors, we don’t throw up our hands when our patients cannot afford their medications.  We roll up our sleeves and help them find cheaper alternatives.  Often, that means diverting time to calling around to different pharmacies, searching the internet for discount drug programs, and completing mountains of prior authorization paperwork to get the treatment that over a decade of training and clinical experience tell me is right for the person sitting in front of me.  The price tag often says otherwise.

And, with physician shortages throughout the country, these hours spent means even longer wait times for a routine checkup, potentially delaying treatable disease.  The prior authorization calls I have to make from the hospital mean longer lengths of stay, delaying the important work of rehab.  The preventable hospitalization for someone who could not afford insulin means the patient in Houlton has to wait longer to be transferred for highly-specialized care.  My patients are rightly frustrated at the medical system and my colleagues increasingly demoralized.  The rising drug costs rippling through our health system now feel like a tsunami, and my patients tell me they are drowning.

The legislation before you today would help to ensure high quality of care, lower the overall costs of health care in Maine, and retain medical providers in high-need and underserved communities across the state.  I am happy to answer any questions you have and to be a resource to you in the future.

  1. American College of Physicians Fact Sheet
  2. “Stemming the Escalating Cost of Prescription Drugs: A Position Paper of the American College of Physicians.” Hilary Daniel, BS; Annals of Internal Medicine, 5 July 2016.
  3. Statement for the Record from the American College of Physicians to the United States House Chairman and Ranking Member of the Committee on Ways and Means dated February 12 2019. “The Rising Cost of Prescription Drug Prices.”
  4. Statement for the Record from the American College of Physicians to Chairman and Ranking Member of the United States Senate Committee on Finance dated January 29, 2019. “Hearing on Drug Prices in America: A Prescription for Change.”