Lawmakers are weighing an array of pharmacy bills this session that could rein in prescription prices and allow pharmacists to treat people for COVID-19

By Ben Botkin, Oregon Capital Chronicle 

Oregon lawmakers are trying to cut down health care costs for Oregonians with a bill that would squeeze more savings out of the prescription discounts people receive from drug makers.

Rep. Emerson Levy, D-Bend, is sponsoring a proposal that would allow Oregonians to put any financial assistance they receive from a pharmaceutical manufacturer towards their health insurance deductible. Pharmaceutical manufacturers sometimes offer discounts, also called co-pay assistance programs, as a tool to encourage people to use medications. 

But commercial health insurers often don’t count that assistance towards a person’s annual deductible, which forces them to wait longer and spend more before all their health care costs are covered. Insurers require that patients meet deductibles before full coverage kicks in. The discounts allow people to choose more expensive medications than they otherwise might, according to an analysis of the proposal. Some drugs don’t have cheaper generic equivalents.

House Bill 4113 would force insurers to accept the coupons and third-party discounts toward a person’s deductible when they help pay for prescriptions.

“Oregonians that pay for their insurance should be able to use it, but because of co-pay limiter programs, each visit to the pharmacy counter can be a game of health care roulette,” Levy said in a statement.

The bill, heard Wednesday in the House Committee on Behavioral Health and Health Care, could be put to a committee vote on Monday. 

Patients advocates spoke in favor of the bill, saying patients stop taking life-saving medications when the costs grow beyond their means to pay for them. For example, people with HIV don’t have a wide array of inexpensive generic drugs, said Jonathan Frochtzwajg, public policy manager for Cascade AIDS Project, the largest provider of services for people with HIV in Oregon. 

“For some, the only way they can afford their meds is by using co-pay assistance to reach their annual deductible,” Frochtzwajg said in submitted testimony. “When insurance companies don’t count co-pay assistance toward consumers’ deductibles, even for drugs with no generic equivalent, it puts people living with HIV at risk of falling out of treatment, and undercuts public-health efforts to end the HIV epidemic.”

The Chronic Disease Coalition, a national nonprofit based in Portland, told lawmakers that the bill would put patient assistance dollars where they belong.

“Simply put, if money is put into the system to benefit a patient, it should,” said Nathaniel Brown, director of advocacy for the coalition.

But an Oregon insurance company warned the bill could have unintended consequences. Cambia Health Solutions, which operates insurer Regence BlueCross BlueShield of Oregon, told lawmakers the bill fails to address the underlying problem of high drug costs.

For example, some manufacturers limit discounts for a set number of refills, Mary Anne Cooper, Oregon director of government relations for Cambia Health Solutions, told lawmakers in submitted testimony. As a result, the bill would force insurers to cover the full cost sooner and drive up the costs of insurance, Cooper said. 

“As drafted, we oppose HB 4113, as the benefits would flow overwhelmingly to drug manufacturers and the bill fails to address unjustified high drug prices,” Cooper said.

The bill has support from Republicans and Democrats. Other sponsors include Rep. Cyrus Javadi, R-Tillamook, and Senate Minority Leader Tim Knopp, R-Bend.

Other bills related to pharmacists and prescriptions are:

• Senate Bill 1506 would allow pharmacists to test and treat people for COVID-19. A federal authority that started during the pandemic and allows pharmacists to test and treat for the virus is set to expire on Oct. 1. The bill would extend that authority through June 30, 2026 and require the Oregon Health Authority to reimburse a pharmacist for testing and treatment.
• House Bill 4012 would prohibit health insurers from requiring prescription drugs be dispensed by a specialty pharmacy instead of the provider’s own pharmacy. In testimony, providers, including Oregon Health & Science University, said the requirements can make it difficult for patients to access medication in a timely way. 
• House Bill 4149 would require pharmacy benefit managers to be licensed by the Oregon Department of Consumer and Business Services starting on Jan. 1, 2025. Pharmacy benefit managers are middleman in the prescription drug supply chain, helping manage the supplies between manufacturers, pharmacies and payers. 

In testimony, pharmacists told lawmakers that pharmacy benefit managers need more oversight and have outsized clout to control costs and where patients can get prescriptions. They’ve been accused of making deals with manufacturers that drive up drug costs for patients.

Ben Botkin covers justice, health and social services issues for the Oregon Capital Chronicle.