Healthy Skepticism Library item: 8927

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Publication type: news

Remsen N.
Senate takes aim again at drug companies
Burlington Free Press 2007 Feb 26
http://www.burlingtonfreepress.com/apps/pbcs.dll/article?AID=/20070226/NEWS02/702260302&theme=

Full text:

MONTPELIER — Prescription drug bills are perennial priorities for the Vermont Senate, so it’s not surprising that despite the fanfare about global warming and property tax reform, a drug bill will move this year, too.

“We are doing this as part of an ongoing effort to curb the cost of pharmaceuticals, which are a major driver in the increasing cost of health care,” said Senate Finance Chairwoman Ann Cummings, D-Washington.

“We have to keep the pressure up,” said Sen. Mark MacDonald, D-Orange.

Over the years, Vermont lawmakers and other state legislatures have tried an array of tactics to control drug prices — with mixed success. Cummings said this year’s Senate bill builds on ideas the Legislature endorsed previously that never made it into law, on strategies other states have adopted and on lessons learned from court challenges.

“There is no one way to reduce pharmaceutical costs,” Cummings said. “We are continually trying to get a little more control.”

The bill, which the Senate Finance Committee endorsed last week by a 6-1 vote, is a grab bag of initiatives. Two proposals have attracted opposition from drug manufacturers. One gives the state a way to sue drug companies for “unconscionable pricing” of medicines necessary to treat significant public health problems. Another shuts the door on information about physician prescribing patterns that drug companies have used to tailor their sales pitches to individual doctors.

The bill would also require the state’s subsidized health care program to consult independent researchers about the effectiveness of various drugs. The information would be used in making choices about the drugs the state prefers doctors to prescribe to Medicaid patients.

The bill calls for the Department of Health to set up a drug education program for physicians to counter the marketing efforts by drug companies. It requires organizations that manage prescription drug programs for health insurers to disclose any rebates or incentives they get from drug manufacturers in exchange for price discounts.

The Senate Health and Welfare Committee will spend most of this week reviewing the many initiatives in the bill before making its recommendation on passage and sending the legislation to the Senate floor.

Fighting the bill

The Pharmaceutical Research and Manufacturers of America sent a team to Vermont last week to testify against the bill, and individual drug companies have hired local lobbyists to try to persuade lawmakers to abandon the two most controversial provisions — unconscionable pricing and doctor’s prescribing data.

Julie Corcoran, deputy vice president for state policy at PhRMA, told lawmakers that the unconscionable pricing provision would likely face a court challenge because Vermont can’t regulate interstate commerce.

Cummings counters, “We can’t regulate interstate commerce unless there is an overriding state interest.” The bill establishes the procedure to declare an overriding state interest.

Under this provision, the attorney general could sue a drug manufacturer for unconscionable pricing if the commissioner of health identified a serious health condition and the price for a drug used to treat the condition was high and affected Vermonters’ access to the medicine. The bill says an unconscionably high price would exist when the wholesale price in Vermont was 30 percent above prices of the drug for federal agencies or other groups who get big discounts.

Corcoran warned that if the state sued over price, the result might be that a drug couldn’t be sold during the course of the litigation.

Cummings said she’s hopeful the provision serves as a deterrent to prevent unconscionable pricing from ever happening.

Corcoran also objected to the bill’s intention to prevent organizations called “data miners” from assembling information about physician prescribing practices and selling it to drug companies who share it with their sales staff.

Robert Hunkler works for IMS Health, one of the data mining companies. “This kind of bill robs the health care system of vital information,” he argued, noting that his company provides information to researchers and government and to drug companies.

Corcoran said the American Medical Association has a program that allows physicians to sign up to have blocks put on their prescribing data for up to three years. This addresses doctors’ concerns, she said. Legislation isn’t needed.

The Vermont Medical Society disagrees. Although it advises Vermont doctors about the AMA program, Madeleine Mongan, director of government relations for the Vermont Medical Society, said, “We don’t think opt out works very well.”

The medical society supports the ban on the use of physician prescribing data for marketing. Under the bill, drug salespeople could still visit doctors’ offices and make their pitches, Mongan said, “but they can’t know what you are prescribing.”

The bill has yet to run into significant political roadblocks. Officials from several state agencies helped refine its language and say they are satisfied with the legislation as it passed from the Senate Finance Committee.

Joshua Slen, director of the Office of Vermont Health Access, praised the provisions affecting his agency, such as the requirement that a drug-utilization board look at research on drug effectiveness in developing a preferred drug list. “How could we be against that?”

The consumer arm of the Office of the Attorney General embraces the legislation and will help usher it through the Statehouse.

“This is an important bill from our perspective for consumers and taxpayers,” Assistant Attorney General Julie Brill said. “The state and health plans spend a lot of money on pharmaceuticals. They get great value,” Brill said. The bill ensures that Vermonters continue to get value “without extra padding.”

Contact Nancy Remsen at nremsen@bfp.burlingfreepress.com