An advocate for those with diabetes is urging Maine lawmakers to require that prescription drug rebates be passed along to consumers.
George Huntley, CEO of the Diabetes Patient Advocacy Coalition, said negotiations over drug prices result in benefits for insurance companies. He wants those benefits to flow to consumers instead.
“Even though they have paid a premium to get access to Sam’s Club, they aren’t getting Sam’s Club pricing,” he told members of the Legislature’s Health Coverage, Insurance and Financial Services Committee on Thursday.
A new bill, sponsored by Rep. Margaret Craven (D-Lewiston), attempts to require insurance companies to give rebates negotiated by pharmacy benefit managers to consumers, rather than back to the insurance companies.
Current state law allows insurance companies to keep the rebates as long as they demonstrate that they are using the rebates to control premium costs.
The bill is supported by Legal Services for the Elderly, Epilepsy Foundation New England, the National Alliance on Mental Illness Maine and several other groups.
The cost of prescription drugs, particularly insulin, has been highlighted in recent months at the federal level. In January, a $35 per month cap on the cost of insulin went into effect for nearly four million seniors on Medicare.
In his State of the Union Address, President Joe Biden called for the cap to apply to everyone, not just those on Medicare, which is for those 65 and older.
But the state-level effort to lower the cost of prescriptions is opposed by the Pharmaceutical Care Management Association, which represents pharmacy benefit managers. Those managers — the two largest are CVS CareMark and Express Scripts — work with major insurance companies to administer prescription drug plans.
As it is now, the managers negotiate lower drug prices for the insurance companies, which reap the benefits of lower costs. That allows them to keep premiums for all customers lower, said Sam Hallemeier, director of state affairs for the care management association.
If the state requires those savings to be passed directly to consumers, it could raise premiums, he said.
“This proposal would only help a small population of the benefit, 10% in fact, while raising premiums for everyone else,” he said.
Kristine Ossenfort, director of government relations for Anthem Blue Cross/Blue Shield, said consumers in Maine benefit from lower premiums because the money saved is passed on to them.
“The real root of the problem here is prescription drug costs and this proposal does nothing to address that issue,” she said.
Attorney John Brautigam, who represents Legal Services for the Elderly, acknowledged that there may be a trade-off between passing along cost savings to those who are buying medicine and potentially increasing premiums.
“LD 1165 seeks to ensure that incentives, rebates, or other payments directly benefit the individual covered person,” he said. “It reflects a long history whereby various innovations have not trickled down to help those who most need assistance.”