The EACH/PIC Coalition submitted comments to the Delaware Senate Health and Social Services Committee opposing provisions in SJR 7, which would cap reimbursement rates at the “maximum fair price” rates negotiated in the federal Medicare program.
The letter stated:
“We share with you the goals of lowering patient out-of-pocket (OOP) costs and ensuring current and retired State employees 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.
“The EACH/PIC coalition maintains that medical determinations regarding which treatments 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 (including Maryland) as they create a new incentive structure for payers that is likely to compromise patient access to selected medications as those drugs are consequently removed from drug formularies or shifted to higher cost-sharing tiers.
“The proposal in 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.”