A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

An Rx for Public Health: Prescription Drug Affordability & Transparency

An Rx for Public Health: Prescription Drug Affordability & Transparency

April 3, 2019

As many of us have experienced first-hand, taking a regular regimen of medication prescribed by a provider can have remarkable effects on the quality of our daily lives and our ability to build a healthy future for ourselves and those around us. Prescription drugs are critical to curing disease, managing medical conditions, controlling debilitating symptoms and helping us avoid the need for more serious and expensive care. In short, prescription drugs bring hope and improved health to individuals and families and contribute to the public health of the Commonwealth every day.

But there is more to the story: Prescription drugs don’t work if people can’t afford them, and too many people in Massachusetts can’t afford the high cost of prescription drugs. Consider John, who reached out to Health Care For All (HCFA) for help. John had suffered a stroke and a heart attack but was forced to wean himself off of most of his medications because he could not afford the co-pays under his wife’s insurance plan. After his wife passed away, John was working part-time and staying at friends’ homes and in hotel rooms. HCFA helped him complete an application for MassHealth, but while he was trying to find a doctor and waiting to receive verification of his income for his coverage, he ran out of medication. John ended up in the emergency room and, because of all this, he lost his job. The good news is that HCFA’s HelpLine counselors were able to finalize John’s MassHealth enrollment, and helped him fill the prescription while he was in the hospital. The reality is that the unaffordability of his prescription drugs had a negative impact on John, his health, and his life multiple times over the course of this time period.

Stories like John’s are common – and such anecdotal evidence is backed up by multiple studies that show that high cost-sharing for prescription drugs leads patients not to take the drugs their doctors prescribe. The affordability of prescription drugs goes to the core of health justice. Access to life-changing and life-saving prescription drugs must be a right for all who need them – not a privilege reserved for those who can afford them.

As a result, HCFA is leading the charge here in Massachusetts to make prescription drugs more affordable for consumers and increase the transparency surrounding what it actually costs to produce a drug. Along with lead sponsors Representative Christine Barber and Senator Jason Lewis, HCFA filed An Act to Ensure Prescription Drug Cost Transparency and Affordability (HB 1133 / SB 706). This bill seeks to:

  • Make drugs affordable and available to consumers
  • Make pharmaceutical costs more transparent and affordable for the health care system
  • Contain costs for MassHealth
  • Require the pharmaceutical industry to do their fair share to control health care costs

This legislation uses a number of strategies that include providing transparency around the underlying costs to produce prescription drugs; restraining abuses of pharmacy benefit managers (PBMs); authorizing the HPC to set upper payment limits for unreasonably high-priced drugs; requiring pharmacists to inform consumers if purchasing a drug at the retail price would be cheaper than using health insurance; providing tools to strengthen MassHealth’s ability to negotiate lower drug prices; and permanently authorizing and funding “academic detailing,” an evidence-based prescriber education program.

Personal stories are a powerful tool when advocating for change. If you or a family member have struggled to afford prescription drugs, and want to share your story, please contact Yaminah Romulus at yromulus@hcfama.org.

- Natalie Litton, Policy & Project Coordinator, Health Care For All

 

This blog is part of HCFA’s 2019 Public Health Awareness Week series.