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Senate of Pennsylvania
Session of 2013 - 2014 Regular Session


Posted: March 1, 2013 02:41 PM
From: Senator Bob Mensch
To: All Senate members
Subject: A Study of Specialty Tier Prescription Drugs
I am introducing legislation to direct the Legislative Budget and Finance Committee (LBFC) to conduct a study of specialty tier prescription drugs to determine the impact on access and patient care.

Specialty drugs are classified by Medicare as those costing more than $600 per month. They are commonly prescribed and often the most effective means to treat conditions such as hemophilia, human immunodeficiency virus (HIV), hepatitis, multiple sclerosis, lupus, some cancers, and rheumatoid arthritis, among others.

The number of specialty drugs is expected to grow more than 25 percent per year, both in increased utilization and increased unit cost. Many specialty drugs, including those known as biologics which are derived from living organisms, do not have a generic equivalent. In response, payers are shifting from prescription coverage with a fixed-dollar copay to coinsurance which requires a percentage of cost-sharing, typically 25 percent to 33 percent of the drug’s total cost.

This change can make drug treatments unaffordable to patients. For instances, two new oral drugs released in May, IncivekTM (telaprevir) and VictrelisTM (boceprevir), represent a true breakthrough for patients with hepatitis C. However, each round of treatment for these drugs costs between $24,000 and $50,000. Using conservative figures, one round of treatment of Incivek would cost a patient at least $6,000 if it is within a specialty tier for their coinsurance.

My legislation aims to examine the affect specialty tier drugs are having on the care and treatment of patients. If you have any questions regarding this legislation, please call Geri Sarfert at 7-1640.

Introduced as SR70