PhRMA Likely to Win Support for Watering Down Prior Authorization of New Drugs
The Pharmaceutical Researchers and Manufacturers of America appear likely to succeed at watering down a bill designed to give the Oregon Health Authority the chance to screen new blockbuster drugs before they are given to Medicaid patients.
House Bill 2638 would allow a six-month period where any new drugs on the market would have to face strict hurdles before being dispensed for a Medicaid member. In the meantime, the state’s Pharmacy & Therapeutics Committee would weigh the scientific evidence of the drug’s efficacy.
PhRMA has proposed two amendments that would reduce the state’s ability to limit unfettered access to expensive new drugs. One would perpetuate the lack of sideboards on psychiatric medications by exempting them from the policy, while the other would strip the Health Authority of any ability to use this tool to design effective prescription drug policies.
HB 2638 passed the House unanimously. PhRMA waited for the bill to come to the Senate Health Committee before proposing its amendments, indubitably aware it would find a more sympathetic audience before Chairwoman Sen. Laurie Monnes Anderson, D-Gresham, than the House Health Committee, chaired by Rep. Mitch Greenlick, D-Portland.
The psychiatric drug amendment seemed almost certain to be slapped on HB 2638, while Sen. Elizabeth Steiner Hayward, D-Portland, waged a strong rhetorical fight to stop the second one, which would prevent the state from developing a cost-benefit analysis before automatically dispensing new drugs.
The bill only applies to Medicaid members who receive health benefits directly from the state; coordinated care organizations can require prior authorization of drugs for its members, with the exception of psychiatric medication. A bill earlier this session to create a pathway to CCO control over those medications died without a vote in the House Health Committee.
Not coincidentally, Steiner Hayward is the only member of the Senate Health Committee not to accept campaign contributions from the pharmaceutical industry. She opposed both amendments.
The other four members have all been rewarded for their support of policies that favor the pharmaceutical industry with handsome campaign contributions. Monnes Anderson, Sen. Tim Knopp, R-Bend, and Sen. Jeff Kruse, R-Roseburg each received at least $7,000 each between the 2013 and 2015 sessions.
Sen. Chip Shields, D-Portland, said he understood the cost incentive for giving the state the ability to hold up new drugs, given the eye-popping cost of drugs like Solvaldi, for Hepatitis C, but said it was less clear how delaying these drugs would help patients. “These blockbuster drugs are coming down the pike,” Shields said. “It seems all of this is about controlling costs.”
But Steiner Hayward argued that the prior authorization process was already universal among private health plans, as well as coordinated care organizations. “This is exactly what happens for every one of us with commercial insurance,” said Steiner Hayward.
Without the bill, the Health Authority would have to wait until the Pharmacy & Therapeutics Committee deliberated before it could establish guidelines about when and how a drug should be prescribed, leaving unfettered access when the drug comes onto the market.
Trevor Douglas, a policy manager at the Oregon Health Authority, testified that HB 2638 would not block the drugs from patients with a clear need for the new medications, and the restrictions on access would only last for the lesser of six months or a determination by the Pharmacy & Therapeutics Committee.