The July meeting involved public comment and board inquiry from stakeholders.
Patient and consumer panel
Mark Sturbois, terminal cancer patient, and senior citizen on Medicare and hepatitis C patients stated that he wants new research to continue and blames PBMs for costs.
Insurance company panel
Board question: Considering the pass-through model from West Virginia, how would PBMs be held accountable if UPLs were implemented?
PCMA said that UPLs hamper PBMs ability to negotiate lower drug prices “across the board for the client.” Board members questioned this extensively.
Insurance companies said that the UPLs would cause losses for pharmacists and distribute costs to members. Also concerned about interstate commerce issues.
Manufacturer panel
- Brett Michelin, Senior Director, State Government Affairs, Association for Accessible Medicines (generic and biosimilars)
- Brian Warren, Senior Director, State Government Affairs, Bio
- Liisa Bozinovic, Executive Director, Oregon Bioscience Association
- Dharia McGrew, Director, State Policy, PhRMA
Panelists stated that the board needs to consider the perspectives of specialist providers who will consider some alternative medications infeasible or outdated. They should also consider that patients are buying higher cost drugs instead of lower cost generic versions. They also need to recognize that cost recouping funds research and rare disease groups that will be impacted substantially. Additionally, untested regulation can chill bioscience industry development in the state.
Advocacy group panel
Board question: What groups should be involved in the study and what questions should the board ask:
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- AARP Public Policy Institute
- AiArthritis IFFAAA
- Bleeding Disorders Counsel
- Can Do Multiple Sclerosis
- Caring Ambassadors Program
- Global Healthy Living Foundation
- Multiple Sclerosis Association of America
- Multiple Sclerosis Foundation
- National Bleeding Disorders Foundation
- National Multiple Sclerosis Society
- National Psoriasis Foundation
- Oregon Coalition for Affordable Prescriptions
- Partnership to Improve Patient Care
- Oregon State Public Interest Research Group
Advocates requested that rare disease and chronic disease patients be treated fairly. UPLs may impact future medicine supply chains and force patients to use substitute medications that have other external costs. For example, capping insulin caused manufacturers to stop production and shift to more profitable medications, which created shortages. Drug prices need to be addressed for all drugs, not just those few deemed unaffordable by the board.
Because UPLs function as a reimbursement cap, they are driving pharmacies to avoid stocking medications that they would sell at a loss. This is impacting patients who need immediate, long term drugs. Additionally medical providers who treat patients in clinics may be impacted by UPLs, hurting their ability to service patients.
Pharmacy panel
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- Albertsons
- AlignRx
- American Pharmacists Association
- Ardon Health Holdings
- Broadway Pharmacy, North Bend
- Brooklyn Pharmacy, Portland
- Hi-School Pharmacy
- Independent Pharmacy Cooperative
- Irby Pharmacy, Veronia
- LaClinica, Medford
- Managed Healthcare Pharmacy, Eugence
- NACDS
- St. Charles Health System
- Oregon State Pharmacy Association
Board question: Pharmacies have suggested that drug importation may be a potential solution for affordability issues. What challenges do you see for drug importation?
The pharmacists stated and restated that importation is counterproductive to the conversation. It will be expensive and have administrative hurdles. Pharmacists reiterated that the UPL is the bigger problem for pharmacists. As long as importers meet all FDA and DSCSA requirements, they will not be an issue, however PBMs are setting costs that cause pharmacies to lose money on prescriptions.
Drug importation programs are not the solution to decrease the costs. They haven’t seen decreased costs for patients in other states from importation, but they have seen increased risk of opportunities for mishap and rogue activities that create patient risks.
Board question: As it relates to UPLs, what suggestions do you have for the board regarding the UPL model and how would you propose that the patients and providers be protected?
Look towards the federal Inflation Reduction Act which allows the federal government to negotiate with manufacturers for the price of drugs in Medicare Part D. In other states, the PBM can shortchange the pharmacy. Ensure an attached dispensing fee for pharmacy service. Additionally, UPL may only apply to certain patients. How will this be managed at the pharmacy level? If you implement a UPL, you will be impacting the PBM contracts. Pharmacies have costs associated with dispensing, if you talk only about the ingredient cost, you’re not addressing the cost of providing, dispensing and administering drugs.
Hospital, FQHC and provider panel
Board question: Are there contractual problems that UPLs would cause? Would 340B entities help us in this process?
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- Cascadia Health, Portland
- Central City Concern, Portland
- Kaiser Permanente
- La Pine Community Health Center
- Advent Health Columbia Gorge
- Multnomah County Health Department
- Nara Northwest
- Neighborhood Health Center, Seattle
- One Community Health, Hood River
- Oregon Primary Care Association
- River Bend Hospital, Springfield
- Rogue Community Health, Medford
- Salem Health Hospitals and Clinics
- Samaritan Health Services, Corvallis
- Virginia Garcia Memorial Health Center, Hillsboro
- Yakima Valley Farm Workers Clinic
Multiple representatives from hospitals and clinics said that there were no known contractual problems, but UPLs have an impact on the pharmacy business, and dispensing fees are less than $1. UPLs make it more difficult for pharmacies to serve patients. “Tinkering” with the 340B program “around the edges” on the state level will cause patients to lose access. Please carve out 340B entities from the UPLs. Implementing UPLs will fundamentally limit access to health care for the vulnerable.
Written comments were submitted by:
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- Bridget Walsh, VP, Government Affairs and Public Policy, Boehringer Ingelheim
- Blasine Penkowski, Chief Strategic Customer Officer, Johnson & Johnson Health Care Systems Inc.
- Harmeet Dhillon Head, Public Policy GSK and Carie Harter Senior Director, Government Relations ViiV
The next meeting of the PDAB is August 21, 2024. There will be a presentation on the Upper Payment Limit deliverable (SB192) and a discussion on the affordability review process.
