Our health care system should start with patients
An older man walked into my clinic last winter for a diabetes-related checkup and told me that he had started taking smaller doses of his insulin, sometimes skipping it altogether, so he could stretch out his prescription. The cost of his life-saving medication was so high that he was putting himself at risk for deadly consequences like a diabetic coma, kidney disease, and heart disease.
Doctors across the state are hearing the same stories. Whether patients are near the Canadian or the Iowa border, they are struggling to cope with out-of-reach prescription drug prices. People in Minnesota shouldn’t lose loved ones because the cost of their insulin – a drug that costs approximately $5 to manufacture -- shot up to $1,200 overnight. Waiting for someone to create a GoFundMe page should not be our safety net.
And it’s not only insulin. The United States spends more on health care and pharmaceutical drugs than any other high-income country, yet we experience worse health outcomes.
Why is this happening? For too long, the health care conversation has focused on how policies will impact businesses or hurt their stock performance. We rarely hear concerns about how policy will impact patients. It’s easy to sit in a board room and wonder if covering medicine for the sick is feasible. It’s not so easy to tell those patients in my clinic that finding a better option for treatment isn’t feasible.
We can craft health care policy that both helps people and is economically sound. And the good news is the Minnesota House has a plan to do so. I’ve worked with my colleagues to introduce a package of seven bills aimed at protecting patients from profit-driven health care companies, ending price gouging, and leveraging the state’s purchasing power to bring down costs. Unfortunately, only two of those seven bills have been given a hearing by the Republican-controlled Senate.
A bill that I introduced, and worked with the Senate to advance, (House File 728), would regulate, require more transparency from, and create fiduciary responsibilities for Pharmacy Benefit Managers (PBMs). Currently, Big Pharma and insurance middlemen can pull the rug out from patients who rely on life-sustaining medications by suddenly raising prices or changing coverage.
This is what happens: PBMs negotiate prices with drug manufactures. The PBMs require a kick back or a rebate from the manufacturers in order to place their drug on a health plan’s formulary list (the list of drugs that gets offered to the patient). The PBM can then underpay the pharmacy for dispensing that drug. So, now we have manufacturers, distributers, and the PBMs all motivated to bring home the biggest profit.
All transactions with PBMs are “trade secrets.” Yes, we allow one of the biggest players in our health care system to operate in obscurity. West Virginia removed PBMs from their Medical Assistance program and the state saved $38 million dollars.
This freedom to do what they want, without oversight, allows PBMs to switch drugs whenever they can get a higher rebate – sometimes several times a year – which means doctors have to change patients’ prescriptions to medications that are more expensive, and often less effective. Not only can this be destabilizing, but the costs add up - prescription drug spending went up seven percent each year between 2012 and 2016.
Another bill that I’ve introduced (House File 289) would shed sunlight on the negotiation of these drugs from the manufacturer all the way to when these medications reach the patient. This would both increase accountability, and reduce the costs of insulin and other diabetic drugs. And yet, Senate Republicans haven’t found the time to give this bill a hearing.
Health care coverage should not be a partisan issue. Large corporations simply should not profit off the people facing illnesses in this state.
I urge my colleagues to put aside profit-centered health care solutions, and begin prioritizing patient-centered ones.
Representative Alice Mann (DFL – Lakeville) has served patients at Northfield Hospital’s Lakeville Family Health Clinic and at Northfield Hospital’s Emergency Room.