Maine lawmakers, activists discuss next step in fight to lower drug prices for all – mainebeacon.com

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On the heels of Democrats’ passage of what they are heralding as a drug price reform bill decades in the making, health care advocates, state lawmakers and impacted people in Maine met on Thursday to assess the bill and discuss what still needs to be done on both the state and federal levels to fight high medication costs.
They said urgent action is still needed as the prices of the 20 most commonly prescribed name-brand drugs for seniors has risen in recent years nearly 10 times more than the rate of inflation. 
To meet that need, the White House said that the Inflation Reduction Act, which passed on a party-line vote last month, will “cap prescription drug costs for hundreds of thousands of Maine Medicare beneficiaries, reduce health insurance premiums for tens of thousands of Mainers by hundreds of dollars per year on average while expanding coverage to about 14,000 Mainers, and cap insulin co-payments for the thousands of Maine Medicare beneficiaries that use insulin.” 
Legislators Sen. Ned Claxton (D-Androscoggin), Rep. Richard Evans (D-Dover-Foxcroft) and Rep. Heidi Brooks (D-Lewiston) along with Megan DesCamps, U.S. Sen. Angus King’s senior policy advisor on health issues, spoke at the virtual forum hosted by the Maine People’s Alliance (of which Beacon is a project).
Medicare reforms provide ‘underlying framework’ for future efforts
DesCamp said that the IRA is a “huge step forward,” but conceded that the measure doesn’t contain everything Maine’s independent senator wanted.
“One part that I think a lot of people were disappointed in is that some of the prescription drugs and savings pieces didn’t go as far as the original Build Back Better,” she said, referring to the sweeping Democratic agenda that was scuttled by the party’s conservative members last year. 
“In negotiations it was pared down quite a bit to meet some of the demands or parameters that some members felt they could support,” DesCamp said. She suggested, however, that the legislation did provide “an underlying framework now that we can build on.”
Rather than providing across the board prescription drug reform, the IRA limits its scope to seniors on Medicare. For Medicare beneficiaries, the legislation caps overall out-of-pocket drug costs at $2,000 a year, limits out-of-pocket spending on insulin to $35 per month, and requires drug companies to pay a rebate to the government if prices rise faster than inflation.
The legislation also — for the first time — will allow Medicare to negotiate directly with drug manufacturers over the price of some drugs beginning in 2026. Under Build Back Better, the negotiated prices would have been accessible to all insurance payers, a proposal that has been a campaign promise of Democrats since 2006. But under the IRA, the prices are only available to Medicare recipients.
Some advocates said that was a major shortcoming of the IRA.
“I do not wish to have people at this roundtable confused about what Medicare’s quote, unquote new negotiating power will be. It’s rather small. It applies only to a select number of medications,” said Tom Sterne, a primary care physician and a board member of Maine AllCare, a group that organizes for a universal, single-payer health care system like Medicare for All.
Evans, a doctor and member of the legislature’s Health Coverage, Insurance and Financial Services Committee, echoed Sterne. “Just in this past year, Big Pharma has raised the price of nearly 800 prescription drugs,” he said. “Now, if you were going to try to negotiate on a one-by-one basis, you’re not going to make too much progress.”
He pointed out that the U.S. Department of Veterans Affairs is allowed to negotiate on all drugs for veterans. 
The IRA also extends for three years the enhanced subsidies for the Affordable Care Act’s insurance exchanges that Congress passed last year as part of the American Rescue Plan Act. 
“That really is helping families afford their health care coverage and insurance that they get through the marketplace,” DesCamp said of the additional ACA funding, which she said could save a family as much as $800 a year on average on insurance costs.
She added, “I wanted to stress how important the achievements in the IRA were, and hopefully families will begin to benefit and we’ll improve affordability further going into the future.”
Drug patent reform
While advocates said the IRA was a necessary step, they said much more is needed. Some organizers are presently focusing on pushing Democrats to reform patents, which drug companies use to maintain a monopoly and increase prices.
Robel Worku, an organizer with People’s Action, a national progressive advocacy organization, outlined a campaign to pressure President Joe Biden and U.S. Department of Health and Human Services Secretary Xavier Becerra to sidestep Congressional gridlock to use their executive authority to lift patents on certain high-cost drugs. 
The campaign is focused on making six specific drugs affordable and accessible to everyone who needs them. The medicines include a cancer treatment, a COVID-19 treatment, an HIV prevention drug, a cure for hepatitis C, an inhaler, and insulin. 
“It’s important to remember that these patents are protected by our government,” Worku said. “It’s a situation created by our government where a particular drug company is able to be the exclusive producer and seller of a drug.”
State-level progress
At the state level, Claxton, a retired physician, outlined some of the prescription drug reforms passed by Democrats since they have held control of the Maine House, Senate and Blaine House since 2019. 
Lawmakers have required all insurance providers in Maine to cover birth control and set up the Maine Prescription Drug Affordability Board to compare the prices of the top 100 prescription drugs in the U.S. and Canada. Claxton said the board will help the state, which purchases drugs for the state’s Medicaid recipients as well as state workers, to better negotiate with drug companies.
“I looked randomly on my own at the top 25 meds and in 2020, we would have saved as a state about $4.5 million dollars if we paid anywhere near what Canada pays,” Claxton said.
He said that the board’s purview was a compromise that stemmed from draft legislation that would have addressed drug prices more broadly. 
“We went big and we ended up somewhat smaller,” Claxton said. 
Sterne and others urged lawmakers and organizers to grapple with the underlying structural reasons why prescription drug prices in the U.S. are on average 2.5 times higher than those seen in 32 other nations. Name-brand drug prices are even higher. That is because the U.S. does not regulate or negotiate the prices of new prescription drugs when they come onto the market. Other countries do. 
“It isn’t a question of how heinous the prices are. The question is what to do effectively about it,” Sterne said. “And I would argue that if we focus on nibbling around the edges, one med at a time, can we get this patent undermined, etcetera, it’ll take a century before medication prices are what they should be.”
Evans said he thought the federal government is better suited than state governments to take on the powerful pharmaceutical industry lobby and control drug prices.
“At the state level, we’re only allowed legally to do so much,” Evans said. “Whenever we try to attack one of these problems, you end up getting repelled by Big Pharma and they threaten to sue. And then the states tend to fall for that because they don’t want to become embroiled in disputes. But for Big Pharma, that’s just the cost of doing business.”
Claxton agreed. “I agree that we need to revamp the whole system. But I also think the states with their limited impact can nibble at the edges and do what they can and then look for coalitions across the country,”​​ he said, explaining he has been in talks with lawmakers in other states about setting up bodies similar to the Maine Prescription Drug Affordability Board.
Jennie Pirkle, MPA’s organizing director who worked for years to expand Medicaid in Maine, added: “About nibbling around the edges, I like to think of it more as stepping stones, because we’re in a position where we don’t have the power, we don’t have the hearts and minds that we need to actually get to a full system transformation, which we all desperately know that we need,” she said. “But we need to create those stepping stones to get there. I think there are some good stepping stones in place that we can work on right now.”
Top photo: Lewiston resident Lance holding up a whiteboard at a virtual event in 2020 showing how much he pays for his medications, including insulin. | Carrie Jadud
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