The interim talks in the Utah State Capitol reflect the same unresolved themes as the recently closed legislative assembly, such as improving quality, expanding behavioral health services, and expanding safety nets.
Health and Welfare Interim Committee We met for the first time on Wednesday to discuss interim research items, future legislation to reduce the cost of prescription drugs, and solutions to regulate pharmacy benefit managers (PBMs).
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April 20, Sen, chair of the Interim Committee on Health. Michael Kennedy (R-Alpine) and Rep. Merrill Nelson (R-Grantsville)-Release Research items To work temporarily by the Health Committee.
According to the survey items, the Commission will work on the effectiveness of the community health sector, medical reforms to reduce costs, and improving the quality of health care in the area of behavioral health. Items also include work to review workgroup recommendations for medical cannabis regulation, staffing issues in long-term care facilities, and increased coverage of postnatal Medicaid.
The Committee has tentatively resolved to adopt the above survey items.
Daniel LillienquistSenior Vice President and Chief Strategy Officer of Intermountain Healthcare Civica RxEmphasizes Civica’s work to create cheaper Biosimilar It has the same effect as a well-known brand of insulin.
according to study State insulin prices, implemented by the Utah Insurance Department, rose 14% each year between 2012 and 2018. With this rise, Civica manufactures biosimilars, reducing insulin costs by 85-90%.
Liljenquist recommends that the legislature bring Civica into the pharmacy market and protect it from “retaliation” from major pharmacy manufacturers.He also said the state could contract with Shibika. California We need to lower the prices of Medicaid members and civil servants.
Chet LoftisThe Health and Benefits Managing Director of the Civil Service Health Program (PEHP) has provided up-to-date information on PEHP’s insulin and EpiPen programs to reduce patient out-of-pocket costs. According to Loftis, the state will prepaid the offered rebate amount to PBM so that the patient does not have to pay. Then, when the manufacturer reimburses the rebate plan, the state will reimburse the rebate amount.
“The retail price is $ 350,” Loftis said. “The manufacturer will then pay a rebate equal to the discount. The discount is $ 255. What we are doing is to pay it first on behalf of the state so that the price paid by the members is $ 95. It is to benefit the members by paying. Therefore, the state will fund it in advance. And when that money comes from the manufacturer, we will use it to refund the state. People in Utah can get insulin for $ 95 instead of $ 350. “
Loftis recommends extending this system to lower the cost of medicines for patients and reduce the amount of money PBM receives from rebates.
Other presenters reiterated concerns about the lack of transparency from PBM. Michelle McOnbarThe CEO of the Utah Medical Association said that PBM needs to “pull back the curtain” because it increases costs and adversely affects patient health. She said PBM has too much power, from preparing prescriptions to determining health insurance coverage.
Eric CannonSelect Health’s Chief Pharmacy Officer and Scripius’s General Manager said they created their own PBM due to lack of transparency.
“We found that there was little transparency because we couldn’t openly explain the dollars we were spending,” Cannon said. “Based on information from pharmacies, we knew that we were paying the price, or that the PBM was charging a price much higher than the actual drug price.”
Canon recommended that the legislature promote transparency and find solutions to further regulate what PBM can do and what health insurance and state must report.