The exploding cost of brand-name prescription wonder drugs dominated talk Tuesday at the recent State of Reform conference at the downtown Portland Hilton, and Rep. Mitch Greenlick, D-Portland, put stakeholders on notice that he wants to produce an Oregon remedy for the problem in the next two years.
A complete lack of price controls and large-scale drug price negotiation has put the state’s coordinated care organizations and commercial health insurers in a tricky spot -- while government and pharmaceutical research is releasing scores of wonderful cures for terrible illnesses, the cost of the drugs has capriciously been set at such a high level that taxpayers and consumers may be unable to afford them.
Health plans and the state could be forced to either go for broke -- or play the villain and deny needed care and push the cost onto the sick.
Greenlick told healthcare insiders that he had put a stakeholder group on notice that he expects them to produce some legislative concepts that he will sponsor. “I told them, ‘Do not try to get to a consensus,’” Greenlick recalled. “If you get to a consensus, it will not be dramatic enough to get things done.”
The Portland Democrat said that while Gilead Sciences, producer of a new line of Hepatitis C drugs, nets more than $1 billion in annual profit, he had a constituent who was forced to shoulder $13,000 in one month for the cost of another expensive drug to keep her two children alive, because her insurance plan had a $6,500 per-person out-of-pocket maximum and no discount on the drug coverage. “We can’t have that,” he said.
Dr. Bob Dannenhoffer, a Roseburg pediatrician and health policy leader, likened the problem to malpractice mediation reform in Oregon -- where a solution was reached only after trial lawyers and physicians were willing to meet each other in the middle. “Get some people to sit down in a room and have both be willing to give something up,” he said.
Federal action is also in the works, but progress has been characteristically slow. U.S. Sen. Ron Wyden, D-Oregon, announced an investigation in July 2014 with Sen. Chuck Grassley, R-Iowa, into the prices set by Gilead.
Wyden spokesman Taylor Harvey told The Lund Report earlier this month that Grassley and Wyden are still completing their investigation, and are not ready to make anything public.
In the United States, Gilead has set the price at the highest in the world at $84,000, while offering it for as little as $1,000 in less affluent countries such as Egypt and India. Canada and the European Union, which more actively regulate the pharmaceutical industry, also have cheaper drug costs than the United States, where pharmaceutical companies have spent huge amounts of money on campaigns winning the political support of American politicians both federally and in Oregon to defeat regulation and prevent Medicare from negotiating drug prices.
Wyden and Grassley preside over the federal Medicare and Medicaid budgets as veteran members of the Senate Finance Committee.
Tom Holt, the chief Oregon lobbyist for Cambia Health Solutions, the parent company of Regence BlueCross BlueShield, said there was a whole lineup of drugs that are coming in at a stunning cost that cannot be managed sustainably.
Josh Balloch, the lobbyist for southern Oregon CCO and health plan, All-Care, said the concerns about covering Hep C drugs are just the opening round in a long boxing match where health plans and the public struggle to counter aggressive moves by the pharmaceutical industry that has them on the ropes.
“The cure for cancer may be five years out. It’ll be a fight and a bloody one for the next 15 years,” Balloch said.
The rhetoric about Solvaldi and Hepatitis C at the conference did blur the lines about the actual nature of the disease and the need to reach for the expensive remedy that is purported to cure the illness.
Although millions of Americans carry Hep C, the disease has a very slow progression, and the vast majority are in early stages where the disease is barely detectable and suffer no symptoms. OHSU hepatologist Dr. Atif Zaman told The Lund Report in an earlier interview that those who are in the most need for treatment are in the late stages of the disease, which puts them within five years of suffering cirrhosis of the liver.
Many people who are Hep C positive may never suffer serious liver damage, and if acquisition of the disease was recent from illicit drug use or otherwise, the disease could take decades before causing health problems. The prime candidates for treatment are those who either acquired the disease from sharing heroin needles or cocaine straws with infected users in the 1970s and 1980s or those unlucky Baby Boomers who received a contaminated blood transfusion in that time, when the blood supply was not tested for the virus.
