TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN SUPPORT OF

L.D. 1504, AN ACT TO PROTECT CONSUMERS FROM UNFAIR PRACTICES RELATEDTO PHARMACY BENEFITS MANAGEMENT;

L.D. 1389, AN ACT TO ADDRESS TRANSPARENCY, ACCOUNTABILITY, AND OVERSIGHT OF PHARMACY BENEFIT MANAGERS;

L.D. 1162, AN ACT TO FURTHER EXPAND DRUG PRICE TRANSPARENCY; AND

L.D. 1406, AN ACT TO IMPROVE PRICE TRANSPARENCY OF PRESCRIPTION DRUGS SOLD IN MAINE

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Tuesday, April 16, 2019, 1:00 p.m.

Good afternoon Senator Sanborn, Representative Tepler, and Members of the Joint Standing Committee on Health Coverage, Insurance & Financial Services.  My name is Karen Saylor, M.D. and I am a physician practicing geriatrics in southern Maine.  I am the Chair of the MMA Board of Directors and I am here today to speak in favor of the package of the bills dealing with prescription drug costs which have become a significant barrier to patient access to critical medications. 

The MMA is a professional organization representing more than 4300 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA has decided to testify just once today to convey our support for this Committee’s efforts to improve the transparency of prescription drug prices and also state regulation of pharmacy benefit management in concept.  These are highly technical bills and we are not technical experts on these topics.  But, I can tell you about my “real world” experience and that of my colleagues with patients who struggle too often to cover their prescription drug costs while also paying for other necessities of daily life.

As a geriatrician, I take care of some of your most vulnerable constituents.  I’d like to tell you a story about one such patient.

I was making rounds at a skilled nursing facility in Saco when I was approached by a nurse asking me to help a patient who could not afford her medication.  The patient was a 79-year-old woman who had been hospitalized for pneumonia prior to coming to the facility for rehab.  She had now completed her rehab and was going home that morning.  As part of the discharge process, her medications had been called in to her local pharmacy and her daughter went to pick them up.  During her hospitalization, the patient was newly diagnosed with moderately severe COPD (emphysema) and started on an inhaler called Spiriva, which is standard treatment for this condition.  Now unfortunately, this patient had no prescription drug coverage. 

Would anyone like to venture a guess as to the retail price of this inhaler?  $542.00.  Needless to say, the patient’s daughter could not pay for the medication.  Dr. Saylor, they asked, please can you prescribe something cheaper?  “No problem,” I said. “Let me just get on my GoodRx app and see what we can do.”  Sure enough, the medication was cheaper.  $442.00.  Still out of the question.  I looked up every equivalent drug in that class of medications.  Same results.  “Fine,” I said, “We’ll just use Atrovent.”  Atrovent, or ipratropium, is the oldest drug in this class.  It’s been around since 1986.  We don’t use it much anymore because it is dosed 4 times a day as compared with modern inhalers which are dosed once daily.  So, I looked it up on the app and it was in fact cheaper.  $392.00. 

The patient began to cry. 

The price of new, brand-name drugs has always been higher than generic drugs, but prices today are presenting even greater obstacles to access for many patients than earlier in my career.  Even the price of generic drugs has been skyrocketing.  A study published earlier this year confirmed that the escalating cost of medications is not because of innovative new therapies, as often claimed, but to year-after-year price hikes of medications already on the market.  It is creating a crisis for patients with chronic diseases, like my patient who will literally suffer with every breath because she cannot afford her medicine. 

Regarding the bills addressing state regulation of pharmacy benefit management, the MMA would ask you to be aware of the potential for conflict of interest in the complex relationships among pharmaceutical manufacturers, pharmacy benefit managers, health insurance carriers, and employers/health plan sponsors, and to ensure that rebates obtained by PBMs in negotiations benefit patients and are not simply compensation to the PBM.  Change Healthcare, MaineCare’s PBM, generates hundreds of millions of dollars of rebates for the State and does not keep a percentage of these rebates.

As further background on these issues, I have attached to my testimony, the following correspondence from the American Medical Association:

1. Letter from AMA EVP/CEO James L. Madara, M.D. to DHHS Secretary Alex Azar III and DHHS Inspector General Daniel R. Levinson dated April 5, 2019 re:  Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees (OIG-0936-P);
2. Letter from AMA EVP/CEO James L. Madara, M.D. to the Chairwoman and Ranking Member of the House Energy & Commerce Committee, Subcommittee on Health dated March 27, 2019 re:  prescription drug legislation in the U.S. Congress;
3. Letter from AMA EVP/CEO James L. Madara, M.D. to the Chair and Vice Chair of the National Conference of Insurance Legislators (NCOIL) dated March 13, 2019 re:  NCOIL model legislation on prescription drug costs; and
4. Letter from AMA EVP/CEO James L. Madara, M.D. to the Chairman of the Senate Committee on Health, Labor, Education & Pensions dated March 1, 2019 re:  drivers of health care costs.

Thank you for considering the views of the MMA on the prescription drug bills before you this afternoon and I would be happy to respond to any questions you may have.