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05/13/2021 04:03 PM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20210&cosponId=34597
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House of Representatives
Session of 2021 - 2022 Regular Session

MEMORANDUM

Posted: February 9, 2021 08:55 AM
From: Representative Valerie S. Gaydos
To: All House members
Subject: Prescription drug pricing transparency to reduce prescription abandonment
 
Prescription drug abandonment is a growing concern in the medical community and is a leading cause of drug nonadherence. According to the National Institute of Health, medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Adherence rates for most medications for chronic conditions such as diabetes and hypertension usually fall in the 50% to 60% range, even with patients who have good insurance and drug benefits.

While many factors may contribute to a patient not picking up a prescribed medication, a primary reason for prescription abandonment and nonadherence is believed to be the out-of-pocket cost of medications and not knowing that cost before arriving at the pharmacy to pick it up and pay for it. A recent survey of 1,000 patients revealed that 75 percent received a prescription that cost more than expected and half did not pick-up a prescription because it cost too much when they arrived at the pharmacy. According to adherence statistics obtained by Pillsy, this problem could be solved if the provider had access to prescription costs as they were prescribing the medication and the patient could know the cost and availability of the prescription prior to leaving the office.

To address this issue I plan to introduce legislation that would create transparency in benefits, eligibility and costs for prescription drugs. This bill would require health plans and pharmacy benefit managers (“PBM”) to share certain information with enrollees and health care providers upon request, in the format in which it was requested. This information must be current and include cost sharing information such as what the plan enrollee will pay, utilization management requirements such as prior authorization, and information on appropriate alternatives. Health plans and PBMs are prohibited from restricting health care providers from sharing lower-cost or clinically appropriate alternatives as well as additional payment options with enrollees.

Please join me in increasing transparency related to patient cost, coverage and benefits in the Commonwealth of Pennsylvania.
 



Introduced as HB882