The EACH/PIC Coalition submitted a letter to the Florida House Health and Human Services Committee. The letter urged the committee to oppose legislation that would establish a most-favored-nation (MFN) upperpayment limit for drugs covered by state-regulated health plans.
The letter stated:
“We share H.B. 697’s goal of making drugs more affordable for Floridians and applaud other provisions that prohibit health plans and pharmacy benefit managers (PBMs) from making midyear formulary changes. However, the upper payment limits (UPLs) proposed by the bill fail to address the actual barriers to drug affordability and as shown below are likely to have the unintended and opposite effect of limiting patient access and increasing patient out-of-pocket (OOP) drug costs.”
“Price caps like those proposed in H.B. 697 fail to address the “why” behind drug unaffordability, as they do nothing to alter plan cost-sharing designs or utilization management controls that create direct barriers to affordable quality care. The latest results from our EACH/PIC Patient-Reported Affordability and Unaffordability Survey demonstrates that affordability is not dictated by the list price of a drug but is instead driven by plan design/barriers, cumulative costs, income, and evolving life situations. Furthermore, EACH/PIC’s data revealed existing and often stark health inequities that will only be exacerbated by price caps, as people of color are far less likely to be prescribed or have access to the highest-cost brand name or specialty medications.”
“For these reasons, EACH/PIC urges the committee to remove H.B. 697 provisions that create UPLs as drug affordability for patients is shaped by health plan benefit design and cost-containment protocols that operate independently of artificial price caps. As we discussed during our February 3rd meeting, we strongly recommend the committee instead include non-UPL and patient-centered alternatives that actually translate into lower OOP costs for patients. This includes “delinking” PBM compensation from the price of the drug, so PBMs no longer have the perverse incentive to cover only the highest cost drugs on their formularies (for which they can extract the largest rebates from manufacturers) as well as banning copay accumulator/diversion programs as sought by S.B. 1166 (and already enacted in 26 states including Georgia and Texas).”