The EACH/PIC Coalition submitted written testimony to the Delaware House Health Administration Committee opposing a provision that would cap reimbursement rates at the “maximum fair price” rates negotiated in the federal Medicare program.
The letter stated:
“The proposal in SS1 to SJR 7 would effectively allow the State Employee Benefits Committee (SEBC) to impose the same UPLs or price controls for certain drugs by simply defaulting to the maximum fair price (MFP) negotiated by Medicare. 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 the state employee benefit plan in Delaware.
“Furthermore, applying the Medicare MFP does not guarantee patients will realize any or all of the savings from the lower list price. There is no mechanism for the Delaware Department of Insurance to ensure that the state employee benefit plan (nor any state-regulated health plans) alter their cost-sharing designs for drug products with Medicare MFPs.
“Instead, the price caps proposed in SS1 to SJR 7 could threaten patient access to critically needed drug therapies as manufacturers or the state-contracted PBMs can respond by removing a drug subject to the caps from the formulary offered to current and retired state employees (or imposing higher cost-sharing obligations).” …
“For these reasons, we respectfully urge your committee to reject ineffective and counterproductive proposals like price caps and focus instead on patient-driven reforms that remove barriers to care and drive up costs for patients and providers. More effective reforms include measures to make monthly drug costs more predictable for patients and ensuring that negotiated drug rebates and third-party copay assistance are fully passed on to patients instead of being pocketed by pharmacy benefit managers (PBMs).”