The EACH/PIC Coalition submitted a letter to the Rhode Island Senate Committee on Health and Human Services. The letter urged the committee to oppose legislation that would adopt Medicare’s maximum fair price (MFP) as an upper payment limit for drugs covered by state-regulated health plans.
The letter stated:
“We share with you the goals of lowering patient out-of-pocket (OOP) costs and ensuring all Rhode Islanders can access the medications they need to maintain their health. However, we believe that capping prices at negotiated Medicare payment levels is ineffective at lowering patient costs for prescription drugs and could ultimately cause more harm by creating added barriers between patients and their medically necessary treatment. Therefore, we urge you to oppose this legislation.”
“Our coalition believes that medical determinations regarding which medications are right for each patient should be made solely by the patient and their healthcare providers, not federal and state bureaucrats. We have strongly opposed upper payment limits (UPLs) or “price controls” being set by Prescription Drug Affordability Boards (PDABs) in four states, as they create a new incentive structure for payers that is likely to compromise patient access to selected medications, as those drugs could be removed from drug formularies or shifted to higher cost-sharing tiers.”
“S.B. 2384 effectively allows Rhode Island insurance regulators to impose the same UPLs or price controls for certain drugs by simply defaulting to the Medicare MFP. However, MFPs were determined based on costs under the Medicare program, which are not reflective of the very different and diverse patient populations served by commercial and state health plans in Rhode Island.”