Down on the pharma

May 2, 2016

Our health care system has a drug problem.  I’m referring to the skyrocketing cost of pharmaceuticals.  While concerns about the cost of prescription drugs have been around for decades, the issue has reached a tipping point this year as price inflation has accelerated with no causal link to the costs pharmaceutical companies bear.  Why are pharmaceutical companies increasing prices so fast?  Because they can.

 

There have been the extreme instances of hedge funds masquerading as pharma companies (Turing and Valeant Pharmaceuticals), but more commonly we are seeing companies ramping up prices of both new drugs and old, generics and those still under patent.  Four of the top-10 selling prescription drugs have more than doubled in price since 2011.  The remaining six have seen their prices increase between 54% and 96%.  Closer to home, the Department of VT Health Access (DVHA) reported a 19% increase in spending on prescription drugs in FY’15.

 

In January, Congressman Peter Welch came to the House Health Care Committee to discuss the issue.  While drug pricing certainly has the attention of people like Congressman Welch, he acknowledged the very low likelihood of the U.S. Congress taking any definitive action to address the issue.  The conclusion was that states, not the federal government, need to put in place mechanisms to increase the transparency of pharmaceutical costs and their pricing.  California, Massachusetts, Texas, Oregon, Pennsylvania, North Carolina, Minnesota, and New York are also working on legislation.

 

In the Health Care Committee, we spent weeks debating complicated mechanisms intended to induce pharmaceutical companies to cough up information on their cost structures.  We were reacting to the industry’s insistence that increases in research & development costs were the impetus for price spikes.  We finally settled on a simpler, more direct path that tasks the Green Mountain Care Board and DVHA with annually identifying “up to 15 prescription drugs on which the State spends significant health care dollars and for which the price has increased by 50 percent or more over the past five years or by 15 percent or more over the past 12 months.”  With this list of drugs, the Attorney General’s office will require each drug’s manufacturer to provide the list of factors contributing to the drug’s price increase and the percentage of the total increase attributable to each factor.

 

The bill (S.216) passed the House Health Care Committee unanimously and passed the House by a voice vote.  It’s a first step in shining a light on a huge financial issue for our state.

 

Dental Therapists

 

Last year I began a conversation with Norwich resident Jim Gold about what we could do about the lack of access to dental care in our state, particularly for low-income Vermonters.  While we have made strides in helping Vermonters get health insurance and access to medical care, we have a long way to go on dental care.  Tens of thousands of Vermonters go without needed dental care each year as they live with pain, miss work, and risk serious infection.  Dr. Gold, who’s a retired dentist and has volunteered at the Red Logan Dental Clinic in WRJ, has advocated for licensing dental therapists, a new level of dental professional, in order to increase affordable access to standard and preventative dental care.

 

What is a dental therapist?  A dental therapist is akin to a physician’s assistant in a doctor’s office.  They would have more training than a dental hygienist, but less than a dentist.  There is a list of thirty-four specific services which a dental therapist may perform.  They range from periodontal charting, to application of substances such as fissure sealants, to suture removal, to administering local anesthetic, to re-cementing permanent crowns, to cavity preparation.

 

Vermont Technical College, which already has a program to train dental hygienists, has been prepping a program to train dental therapists.  This course of study would meet the standards set by the Commission on Dental Accreditation, the accrediting body of the American Dental Association, which now recognizes dental therapists as a profession.

 

While dozens of health care and consumer advocates support legislation creating the dental therapist designation, the VT State Dental Society raised concerns that the move would create a two-tiered system where some patients would be able to see a dentist and some would not.  The evidence we looked at strongly suggested otherwise.  Alaska’s new dental therapists have given care access to an additional 45,000 residents, and in Minnesota private practice dentists have found that incorporating dental therapists into their care teams increases the size of their practice while allowing a dentist to focus on the most complex and involved care.

 

In late April, the House passed, S.20, the dental therapist bill 109-32.

 

On a L.A.R.C.

 

Back in January, I co-sponsored H.620 a bill to improve access to contraceptives for both privately-insured and Medicaid patients in Vermont.  With our state being one of the most enlightened in the U.S. with regard to family planning and access to birth control, what’s the issue?  As it turns out, about half of all pregnancies in VT are unintended.  That’s in-line with national averages, but 1.6x the rate of other developed nations.  74% of unintended pregnancies in VT entail medical care paid for by the state at an annual cost of $30 million.  Unintended pregnancies perpetuate cycles of poverty and are associated with adverse maternal and child health outcomes and increased health care costs.

 

H.620 does four things to enhance access to birth control and promote family planning:

  • Allows individuals on private and Medicaid insurance to obtain up to 12 months of oral contraceptives saving regular trips to the pharmacy and increasing the likelihood of consistent use.

  • Expands the birth control benefit to include vasectomies bringing gender parity to insurance support for family planning.

  • Supports an increase in Medicaid reimbursement for LARC (Long Acting Reversible Contraception – the most effective birth control, but also the most expensive) thereby increasing patient access to this method.

  • Codifies the birth control benefit in the Affordable Care Act at the state level, ensuring that VT women have access to contraception regardless of the political environment in Washington.

 

The Health Care Committee approved H.620 without a dissenting vote and passed the House 128-15 at the end of March.  The Senate began working on the bill this week and I am hopeful for its passage before we adjourn. (UPDATE: H.620 passed in its final form on May 4th.  Here's a link to the news story in the Times-Argus piece with a quote from me and Planned Parenthood.)

 

A few pictures to share this week.  The shot below was taken at the State House on April 26th.  It includes Marcos Stafne, the Montshire Museum’s Executive Director, House Speaker Shap Smith, and Beth Krusi, the Montshire’s Director of Communications.  That day Jim and I, along with many other Upper Valley legislators, helped pass House Concurrent Resolution 372 congratulating the Montshire Museum on its 40th anniversary this year.  It was amazing the number of legislators from all over the state who mentioned to me that day how much they love the Montshire.  What a treasure of an institution.

 

 

This picture is from the Vermont Future Summit, an event sponsored by the House Futures Caucus.  This is the first year in the legislature for the Futures Caucus, a group that looks at ways to attract and retain young people to Vermont.  The Summit brought about 50 millennials from around the state to Montpelier to discuss policy ideas to help in this endeavor.  In this picture, Rep. Ram and I are working with a dozen folks in one discussion group.  Some of the concerns raised were very familiar – student debt burdens, housing supply and cost, internet access, social isolation.  Others, like the one our discussion group dissected, involved how to provide millennials access to the professional mentoring they might more easily have access to in an urban setting.  The group liked my brainstorming ideas of eliminating the income tax for VT residents under-30 and providing 20% student debt relief for families under-30 who relocate to VT.  The chairs of the House Appropriations and Ways & Means Committees were not amused!

 

 

This picture is from the April 11th Orange County Democratic legislator’s breakfast at the Local Buzz in Bradford.  Here Michael Shoob of Thetford and I discussed prescription drug costs and pricing transparency.

 

 

Finally, here’s a link to a great YouTube video of the State House edited by Rep. Zagar of Barnard and narrated by Rep. Donovan of Burlington.

 

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