From October 17th to 19th, members of PCG’s Health Policy team attended the annual National Academy of State Health Policy (NASHP) Conference in Pittsburg, PA. The theme for this year’s event was “Where Ideas and Action Converge,” with particular focus on Delivery System Reform Incentive Payment (DSRIP) waivers, Medicaid expansion and payment and delivery system reform innovation. In addition to presentations highlighting the innovative efforts in states under waiver and grant programs, discussions led by state and national policy makers on health care’s more headline grabbing topics (e.g., opiate abuse, ever-growing prescription drug costs, etc.). were weaved through the three-day agenda.
Rising prescription drug costs were the focus of several panels, including the opening morning plenary, a breakfast session entitled “A Call to Action on Pharmacy Prices: Findings from NASHP’s Workgroup,” which kicked off the first full day of the conference. The panel was led by members of the NASHP workgroup: Trish Riley, Executive Director, NASHP, Nathan Johnson, Chief Policy Officer, Washington State Health Care Authority, Representative Norm Thurston, Utah House District 64, and Ameet Sarpatwari, Instructor in Medicine, Harvard Medical School and Brigham and Women’s Hospital.
NASHP’s workgroup was convened last spring to propose reforms targeted at combating rising prescription drug costs. The group shared their findings in a new report released at the conference, “States and the Rising Cost of Pharmaceuticals: A Call to Action.” The report not only includes steps to ensure consumer protection but also provides actionable ideas that regulators and drug purchasing state agencies (e.g., Medicaid agencies, corrections, public employees) can use to leverage their collective buying power to influence the cost of drugs purchased.
Here are 11 innovative and actionable ways for states to combat rising costs, according to the new report:
1. Increase price transparency to create public visibility and accountability;
2. Create a public utility model to oversee in-state drug prices;
3. Bulk purchase and distribution of high-priced, broadly-indicated drugs that protect public health;
4. Utilize state unfair trade and consumer protection laws to address high drug prices;
5. Seek the ability to re-import drugs from Canada on a state-by-state basis;
6. Pursue Medicaid waivers and legislative changes to promote greater purchasing flexibility;
7. Enable states to operate as pharmacy benefit managers to broaden their purchasing and negotiating powers;
8. Pursue return on investment pricing and forward financing approaches to allow flexible financing based on long-term, avoided costs;
9. Ensure state participation in Medicare Part D through Employer Group Waiver Plans;
10. Protect consumers against misleading marketing;
11. Use shareholder activism through state pension funds to influence pharmaceutical company actions.
We are seeing some of these ideas in action, including the recent action by the Massachusetts Attorney General Maura Healy and her dealings with Gilead Sciences over the cost of the Hepatitis C combination drug Epclusa. (Epclusa combines the high profile drug Sovaldi with Daklinza, priced at $84,000 and $63, 000, respectively.) Attorney General Healey threatened to sue Gilead claiming the pricing of Epclusa (list price $75,000) violated the Commonwealth’s Consumer Protection Act. Gilead Science and the Commonwealth reached an agreement, which went into effect on August 1, 2016 and included drug rebates for some consumers affected by the chronic disease. As a result of this agreement, Gilead’s treatment will be the exclusive therapy for about 80 percent of MassHealth members. The Centers for Medicaid and Medicare Services (CMS) praised this deal as well as its outcome – it is an encouraging step in the right direction as states struggle to keep up with the rising cost of Hepatitis C treatment.
The conference concluded with a panel discussion entitled “Looking Ahead: A Preview from NASHP’s Leaders’ Summit - State Health Policy Meets a New Administration.” Leaders from the state policy and medical communities explored the potential challenges and opportunities of a new administration and how states and the federal government can work together to continue to effect reforms. PCG is also tackling this topic by creating an internal workgroup of our subject matter experts to develop resources and assist our clients as we work through the administrative change. We will be sharing our results in Health Policy News so stay tuned!
NASHP 2016 offered us an opportunity to gain the unique perspective of the many innovative solutions states are implementing to address the challenges of today’s health policy landscape. If you were at NASHP but didn’t have a chance to visit PCG’s booth, please feel free to contact us at firstname.lastname@example.org for more information about our featured projects, including: network adequacy process automation, work with Mississippi to ensure compliance with the new managed care regulations, or our work on the NY DSRIP project.