Gov. Cuomo announced three proposals today that would make prescription drugs more affordable for New Yorkers. Prescription drug costs are a big barrier to care – one survey found that 45 percent of New Yorkers had avoided care, including not filling prescriptions or cutting pills in half, due to costs.

The first would cap insulin prices for insured patients at $100 a month (a similar proposal, A8533/S6492 is moving through the legislature).

The second proposal would give the Department of Financial Services (DFS) the authority to investigate significant spikes in prescription drug costs. DFS would be able to hold hearings at which manufacturers would be publicly asked to justify price spikes. Without a justification, DFS would be able to deny the price change and fine the manufacturer.

The third proposal would create a commission to study whether importing drugs from Canada would save money for consumers and how to ensure that regulations are in place to ensure such a program is safe.

The pharmaceutical industry is feeling pressure from consumers and regulators to justify high drug costs. Here in New York, for example, two early budget proposals would have launched State review of large price increases and instituted price ceilings within the Medicaid program (see HCFANY’s comments on those proposals here). Now KaloBios Pharmaceuticals has released a pricing policy that promises the company will only seek reasonable profits and, most importantly, adopt a transparent price-setting process.

KaloBios was led by Martin Shkreli, who sparked public outrage and Congressional hearings by raising the price of Daraprim by 5,000 percent. There are many complicated reasons why prescription drug prices are increasing. Many of them are legitimate market issues that will require creativity and thoughtfulness to fix. But sometimes drug prices are unaffordable because of price-gouging, something that KaloBios addresses frankly in their new policy. Transparency about the actual costs of producing and selling medications could go a long way towards preventing future Martin Shkreli-style abuses, and allow more productive public discussion about drug prices.

If the company follows through on its promises, it could set an important precedent for other pharmaceutical companies. The fact that the company produced the policy at all shows that consumer voices matter. No law or regulation forced the company to do so – just pressure from the public to treat consumers fairly.

 

 

 

 

 

RWV’s New York intern, Nina Nnamani, shares what she learned about how the Affordable Care Act (ACA) has improved her health insurance coverage.

As a woman in her early 20s, I am among those who benefit most from the health care law. I am in my first year of graduate school and have a lot of things on my “worry list” – assignments that must be turned in, rent that is due, loans that must be paid back and more. However, thanks to the new health care law, affording co-pays for key preventive care isn’t one of my worries.

Under the law, all new insurance plans must cover key preventive care for women without copays. This means that care like birth control or screenings for sexually transmitted infections are provided at no extra cost.

I knew this provision applied to plans starting after August 2012, and that many women would see the changes go into effect in January 2013 (when many new plan years start). But, I didn’t know whether my plan was complying and whether I’d begin seeing coverage without co-pays too.

Well, I checked, and it does! This is the first year that I will be able to get this key preventive care without paying for extra costs. This helps me stay healthy while on a student budget, and allows me to cross one more thing off of my “worry list.”

This provision of the health care law applies to all new plans starting on or after August 2012 (with an exemption for certain religious institutions). Check to see if you are covered too! Ask these questions to find out whether your plan is complying.

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HAPPY VALENTINE‘S DAY!

 

 

The Centers for Medicare and Medicaid Services (CMS) issued a press release this morning with new numbers on just how much seniors and people with disabilities in Medicare have saved as a result of the Affordable Care Act (ACA).

Since the law was enacted, back in March 2010, 5.1 million Medicare enrollees who hit the donut hole have saved $3.5 billion – yes, that’s billion – on prescription drugs.   In 2012 alone, over 400,000 people have saved an average of $724 on prescription drugs, totaling $301.5 million in savings.

Further, since January 1st, more than 12.1 million people in traditional Medicare have been able to get at least one preventive care visit for free.  Last year, over 26 million Medicare enrollees were able to get one or more preventive care visits for free.

The ACA began phasing out the Medicare donut hole last year by offering 7% coverage for generic drugs in the donut hole and a 50% discount on brand name drugs.  This year, Medicare began covering generic drugs in the donut hole at 14%.  By 2020, the ACA will have fully closed the Medicare donut hole.

Not bad, eh?

Click here to read the full press release.