POINT OF VIEW

Keep eye on co-pays: They might actually be higher than RX price

Posted

The efforts of the current Congress to change health insurance hardly encourage hope for controlling drug costs. 

For any substantive change in the next three years, the push to bring prescription drug prices under control has to come from the bottom up. Washington appears to be in a tailspin, evidenced by the constant breaking news headlines, investigations galore, and a series of court rebukes to the attempted policy rollbacks to those of the prior administration. 

The response to those rollbacks should not just be resistance, but local, solutions-oriented thinking on the key issues of our day.

Take health care. This is a crisis that may not get the attention is deserves from the U.S. Senate as it carves up the House version of the American Health Care Act. 

The sick, elderly, poor, disabled, middle and working class deserve better.

In New York, our bottom-up push is about lowering prescription drugs prices — an issue not specifically addressed in the proposed New York Health Act. The United States represents the world’s largest pharmaceutical market; why are we paying two or three times as much as other countries? Wild guess: There are no competitive market forces driving prices.

Well, here is an opportunity to change that through consumer discretion and choice.

This is the right time to push, because there appears to be broad support to lower drug prices. 

A recent Kaiser poll found 60 percent of Americans — including Democrats, Republicans and independents — want action on this.

As a local bottom-up strategy, a coalition of organizations began discussions on crafting a solution in New York in March. Comprising leaders from the New York State Suburban Hospital Alliance, Northwell Health, members of Westchester Home Owners’ Coalition, to name a few, the coalition met over the past three months to build consensus. It also met with the leadership of Westchester County and New York State Medical Society.

The culmination of those meetings led to the two-pronged approach of consumer discretion and choice. The first initiative is in the form of an Assembly bill (A.8046), sponsored by Assemblyman Gary Pretlow, and a companion bill in the senate (S.6629) sponsored by state Sen. George Latimer. It would mandate disclosure of prescription drug prices — prior to the prescription being filled — at the point of sale.

Why? For started, sometimes the co-pay is more than the price, a little known fact. And, when drug prices are disclosed over the counter (or electronically) to a prospective purchaser, that allows for both discretion and convenience to shop around.

Yes, this action is not a panacea — it does not address the internal price dynamics occurring among drug manufacturers, pharmacy benefit managers and insurance companies. But putting control and discretion back in the hands of consumers — which is all they care about — is an important first step.

The second initiative, focused on choice, is to push for New York State to pilot its own single-payer prescription drug dispensary, initially in the Medicaid space, to compete with the status quo. We expect to flesh this out by the fall.

A pilot would allow the state to collect empirical data on what works and what does not, which will be all the more important if Congress imposes “per capita caps” via Medicaid block grants.

With the legislative session ending, lawmakers and Gov. Andrew Cuomo should consider the proposed legislation as the first step in making a difference in the lives of 20 million New Yorkers in the wake of Washington’s inaction.

The author is a former congressional candidate and chair of the Westchester County Home Owners’ Coalition. 

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