GMCB Oversight of Drug Prices (S.98) - Feb 2, 2024

Susan Barrett (Executive Director, Green Mountain Care Board (GMCB)) and Julia Boles (Health Policy Advisor, GMCB) opened the Friday session with Senate Health & Welfare Committee discussing the GMCB. Their mission is to drive system-wide improvements in access, affordability and quality of health care to improve the health of Vermonters. They regulate major areas of Vermont’s health care system in service of the public interest. They also serve as an unbiased source of information and analysis on health system performance. Thirdly, they monitor and evaluate health care payment and delivery system reform to provide public care payment delivery system reform to provide public transparency. 

The role of GMCB is a system-wide view of delivery system, payers, i.e. Medicare, and Medicaid Medicare Advantage plans. They also regulate health insurer rate review Certificate of need (CON). They continued to specifically discuss GMCB’ current data view into prescription drug costs. GMCB receives reporting citing Act 193 of 2018 for major medical health insurers with more than 1,000 covered lives in the state (MVP, BCBVT, and Cigna) overall impact of prescription drugs on premiums. In the regulatory process GMCB sees impact of high prescription drug costs in insurance rate review and hospital budgets.

They cited four states that have authority to view Upper Payment Limits (UPLs) and discussed the process example in Colorado. Their affordability review process selected five drugs to review, and determined Trikafta was not unaffordable for Colorado consumers. Barrett and Boles recommended further discussion, and suggested reviewing how and when drug review would fit into GMCB regulatory schedule and legal review to understand connection with GMCB’s existing authorities. They then discussed building on model language/lessons from other states, and to build on the work of Medicare and other states that have already begun reviewing drugs for affordability. The resources needed would include staffing and funding. The Committee felt they needed more information, including both Federal and State data. They all agreed it would take time to make any decisions.

Beth Anderson (President & CEO, Vermont Information Technology Leaders, Inc (VITL)) then addressed S.173. It is an act relating to the collection, sharing, and selling of consumer health data. VITL is designated to operate the Vermont Health Information Exchange (VHIE), which is a secure, statewide data network that gives health care organizations in Vermont the ability to electronically exchange and access their patients’ health information in order to improve the quality, safety, and cost of patient care. She continued to discuss additional benefits of VITL, stating that they support the proposed bill, however, they request that exemptions be expanded to include VITL.

The language of S.98 was then reviewed by the Committee. The bill proposes to direct the GMCB to evaluate the costs of certain high-cost prescription drugs and recommend methods for addressing those costs, including setting limits on what Vermonters would be expected to pay for some high-cost drugs.

Rachel Cottle Latham from PhRMA was the next to testify, addressing their opposition to S.98. PhRMA strives to conduct effective advocacy for Public Policies that encourage the discovery of important new medicines by biopharmaceutical research. She stated that PhRMA believes that discussions about the affordability of medicines are important, but the intentions of the bill is for government to decide drug prices, which could limit the prescription options available to Vermont. Additionally, she opined that S.98 shortsightedly targets drug spending in ways that likely will have long-term, harmful impacts on innovation and the development of new, life-saving therapies. She also commented that legislation does not account for insurance benefit design issues, and that the bill assumes incorrectly that the price a patient pays is determined solely by drug manufacturers. She concluded that this legislation could harm Vermont’s economy.

Final testimonies were from Theo Kennedy (Public Policy Attorney, Vermont Pharmacy Association) and Jeffrey Hochberg (Director, Rutland Pharmacy Group). Hochberg reviewed how the state's system is broken, citing challenges including Access to Care; transparency in the system; regulation of the system; consumer protection/patient safety; workforce sustainability and concluded that patient costs are rising with access declining. He emphasized the need for adequate data in order for the State to effectively control prescription drug prices by reducing the Pharmacy Benefit Manger’s control over the system through regulation and enforcement. He noted that the current pharmacy pricing is overly complicated with a lack of any perceived transparency.

He further discussed results of inflation concluding that there is complete disassociation from true cots and drug products. He claimed that Vermont will have an Access Issue, as the number of independent pharmacies operating in the state has decreased from 37 in 2010 to 16 now. Pharmacy chains are consolidating and pushing mail-order filling. He recommended further data research and recommended some firms. Kennedy confirmed that both organizations generally support and applaud the purpose of S.98 giving GMCB the statutory authority to comprehensively evaluate the cost of prescription drugs. He opined that the political autonomy and expertise of the GMCB is a good fit for this undertaking is welcome and long overdue. They hope that the GMCB will be given the resources and authorization to do the analytical work first and then make “any recommendations for further legislative action needed to make prescription drugs products more affordable in this State.”

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