In summary

Lawmakers make health care laws to benefit corporations, not patients. This must change.

By Shane Desselle, Special to CalMatters

Shane Desselle is a professor of social and behavioral pharmacy at Touro University in Vallejo and founder and president of Applied Pharmacy Solutions,

Question of the day, or year: Why would an Assembly committee block legislation that would benefit patients rather than wealthy health care corporations? Legislation that would make prescription medications more affordable and accessible for patients. Legislation that is desperately needed.

For decades, patients, advocates and lawmakers have been working hard to pass meaningful health care reform to allow those with chronic illnesses to get the care they need. Yet these reforms continue to be delayed. 

Senate Bill 568, for example, would reduce out-of-pocket costs for patients by prohibiting health plans from requiring patients to pay a deductible before their plan covers their medications. Some patients are forced to pay out-of-pocket costs of more than $1,000 before their insurance will cover their medication. While this patient-centered legislation was allowed an informational hearing in the Assembly Health Committee on July 13, the chair did not allow a vote. The same bill passed out of the state Senate on a 33 to 6 vote.

State senators passed SB 568 because it would bring much-needed relief to the many Californians forced to forgo their medications because they cannot afford them. Multiple patient surveys, including one by the Kaiser Family Foundation, found that one-third of Americans skip or ration their medications because of cost. For Californians, especially those with chronic conditions, not taking medications as prescribed can lead to severe and costly health complications, and even death. 

The Assembly Health Committee chair wanted the bill limited to the four most common chronic disease states: high blood pressure, heart disease, diabetes and asthma. Legislators — particularly members of a health committee — should prioritize improving access and care for all Californians.

Limiting this bill to four disease states would alienate patients with rare or neglected diseases, such as sickle cell disease, lupus and multiple sclerosis.  These patients already face barriers to care because of inadequate funding and support, and many have more problems acquiring coverage and navigating our health care system than those with more common diseases.

Assembly Bill 933, another patient-centered piece of legislation, addresses an abhorrent rebate system that allows health plans and their middlemen to get richer through rebates while patients often pay more than their health plan paid for the same medication. It also was not allowed a hearing in the Assembly Health Committee. 

Under the prescription drug rebate system, health care insurers work with pharmacy benefit managers to ostensibly lower the price they pay drug manufacturers for medications. In what can only be described as a pay-to-play scheme, however, the benefit managers negotiate drug manufacturer rebates in exchange for placing a medication on their health plan client’s drug formulary, with average savings of up to 40% off the list price.

Instead of the savings helping patients pay for their medications or improve care, the benefit managers and the health insurance companies keep the rebates — to the tune of billions of dollars each year. Benefit managers claim that this system helps prevent further increases in health insurance premiums, but peer-reviewed studies have shown this not to be true. 

AB 933 would have made sure that patients, rather than corporations, benefit from discounted drug prices. 

Other states know that this system needs fixing. More than 100 bills regulating pharmacy benefits managers have been introduced in 42 states this year, according to the National Academy for State Health Policy. At least a dozen states have adopted oversight laws. California had an opportunity to lead the nation, but West Virginia was the first state to stand up for patients on this issue.

Contact your Assemblymember and urge them to pressure the Assembly Health Committee to set these bills for a vote and advocate for those who are most affected by these poor political decisions. 

We know what needs to be fixed; we just need more lawmakers to do the right thing. Tell your legislative representative to support patient-centered legislation — even if powerful health care corporations oppose it.

Editor’s note: The text was corrected to more accurately characterize the July 13 vote on Senate Bill 568.

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