After successfully sponsoring legislation to cap insulin prices last year, State Senator Andy Manar is now looking to fix the cost of prescription drug prices and to open up clinical trials for Illinois Medicaid cancer patients.
Manar unveiled a package of healthcare cost legislation earlier this month that would fix the supply chain when it comes to prescription drug costs. “I think we all know that the cost of life-saving prescription drugs are going up exponentially. I think it’s time the government steps in and does something about it. There are limitations as to what the state government can do. Ultimately, the federal government needs to act decisively. We hope to advance legislation to explore and eventually mend the law so that we can have some checks and balances in the system.”
One of the points in the supply chain that Manar hopes to fix or eliminate are pharmacy benefit managers (PBMs). Many within the pharmaceutical industry think that PBMs are necessary in negotiating lower drug costs for their pharmacy clients. Manar believes the secretive negotiations by the PBMs aren’t transparent enough, and he believes they cost taxpayers and prescription medication patients significant amounts of money. “The world existed just fine before PBMs came into existence and employed what I think are darn near criminal business practices towards their competitors utilizing government contracts. We’ve seen any number of state attorneys general file lawsuits against PBMs for their activities. We’ve seen any number of legislatures around the country take the step of limiting the access PBMs have to state Medicaid programs, or eliminating them entirely. That will come with a corresponding savings. I look forward to proving that case, and I look forward to shining a light on these unforeseen actors in the healthcare arena. They will have their chance to make their public case, which they never do by the way. They hide behind a shroud of secrecy and send us the bill.”
Manar says that he hopes to have them testify in public hearings before the General Assembly to attest to their value to the citizens of the State of Illinois. Manar also said he has asked CVS, who is both a brick-and-mortar pharmacy and a PBM, to provide him with the reimbursement rates for the drugs their PBMs distribute to their competitors and he has not received it. “They pay themselves to dispense drugs, so I asked CVS to give me the amount of money that they pay themselves in Staunton at their chain location for filling certain prescriptions and then show me what you pay your competitor across the street, Sullivan’s Drug Store, for the same prescriptions. I still haven’t gotten that information, and I’m a member of the General Assembly. There’s a reason they are not showing me what they pay themselves and what they pay their competitors. I think that is evidence for me to show that they have a rigged system that ends up driving costs up for taxpayers and for consumers.”
Manar says the bills to go after PBMs will only be able to target the state’s Medicaid insurance program’s prescription drug coverage. He says that the PBM issue is indicative of the root problem of the rising costs of health care coverage in the United States.
Manar is also working on giving the state’s Medicaid patients more options for cancer treatment by aligning the state’s insurance program with provisions in the Affordable Care Act’s mandates of experimental and clinical trial treatments for cancer patients. “It’s an end-of-stage, end-of-treatment decision that is made between a doctor and a patient. If traditional methods of battling cancer aren’t working, if that patient has private or Medicare, they would have the option to ask their doctor to go through an experimental trials for those types of treatment. Other states have aligned their Medicare programs with those requirements [in the ACA]; we have not in Illinois. If you are a cancer patient, you have the availability to access those experimental treatment to that cancer, unless you’re a Medicaid recipient. We want to align that.”
Manar says that by aligning with the Affordable Care Act, the cost of Medicaid for the state will not go up. “It will bring options to more people. It will also bolster research, and it will bolster activities in Illinois to continue addressing a robust way, cancer research and the development of new approaches to treating cancer. Not only will it do this, but will do it without expanding the cost of Medicare because a patient doesn’t choose both standard or traditional forms of fighting cancer and experimental treatment. It’s one or the other. When a patient goes to clinical or experimental treatments, that cost is not just borne by the insurance that the patient has, in this case Medicare, but also by those who are promoting the clinical trials.”
The clinical trials bill for Medicare will hear its second reading in the Illinois Senate tomorrow. Manar expects to receive bi-partisan support so that the bill can be on the governor’s desk by late Spring.