Prescription-drug price negotiators are taking stock of new state laws that aim to clamp down on predatorial pharmaceutical practices that some companies worry could hamper efforts to lower medication costs in Georgia.
Patient advocates and representatives from groups called pharmacy benefits managers (PBMs) contracted with health insurers to negotiate lower drug prices are awaiting data from new prescription-cost reporting required in legislation state lawmakers passed last year.
That legislation forces PBMs to start publicly reporting how close to a national average many health plans’ drug prices were negotiated. It also requires that PBMs give state officials some confidential information on rebates and other negotiating tools.
Some PBM representatives worry broader reporting could tie their bargaining hands as they push drug makers to lower costs once the Georgia legislation takes effect in July.
“It definitely affects our ability to watch the market and have those reimbursement rates be more closely aligned with the market,” said Leanne Gassaway, vice president of state government affairs at CVS Health. “I think it’ll take some time to see if those are drastic.”
PBMs have long been part of the complex web of drug manufacturers, insurers and pharmacies that produce, sell and dispense prescriptions in Georgia and across the U.S. They are supposed to act on behalf of patients to drive competition between drug makers and lower prescription costs.
But many pharmacy and patient advocates argue some PBMs in practice become cumbersome middlemen too cozy with pharmaceutical companies that often pocket large rebates and end up contributing to rising drug prices.
Georgia lawmakers have moved in recent years to curb many PBM negotiating practices that advocates consider harmful to patients, said Greg Reybold, vice president of public policy for the Georgia Pharmacy Association. He argued PBMs should face more transparency and reporting rules to keep them honest.
“It’s a mouse trap,” Reybold said. “And the more opaque it is, the more profitable it is for these actors.”
Reybold highlighted one practice known as spread pricing in which advocates say pharmacies are reimbursed less than what health plans pay PBMs for drugs. He pointed to a state report that found PBMs charged several Georgia Medicaid plans more than they reimbursed local pharmacies by roughly $89 million from July 2017 through July 2019.
Recent Georgia legislation aimed to restrict how PBMs can steer patients to certain drug brands, allow the state Department of Insurance to conduct financial and compliance audits of PBMs, and grow the amount pharmacies receive in cost-lowering rebates that drug makers send to PBMs for prescription purchases.
Reybold called those measures a “great start” to boost protections for patients against bad-actor PBMs but said lawmakers “can certainly go further,” particularly after Georgia’s new reporting requirements for PBMs kick in this later year that should paint a better picture of overall drug prices.
“[The reporting] for the first time is going to show that these are the drugs [PBMs] are reimbursing above national acquisition cost and these are the drugs [PBMs] are reimbursing below,” Reybold said.
But tying price reports to the so-called National Average Drug Acquisition Cost – which the recent Georgia legislation requires – could produce an incomplete view of how prescriptions are negotiated by leaving out other pricing benchmarks PBMs use as well as savings from rebates, said CVS Health’s Gassaway.
Some aspects of the new Georgia reporting rules could also force PBMs to show their cards more during the bargaining process, unintentionally decreasing chances to spur the kind of competition between drug makers that helps lower prices, Gassaway said.
Many PBMs already share information on prices and negotiating practices by companies such as CVS Health, which administers prescription-drug plans for Georgia’s state health plan and several Medicaid managed-care providers, Gassaway said. Opening up that information to more eyes could potentially do more harm than good, she said.
“We don’t believe having that kind of competitive information or proprietary price information out in the public domain would actually enhance competition or lower drug prices,” Gassaway said. “But we do believe in being transparent with our clients so they know where their money is going.”
The COVID-19 pandemic has also stressed PBMs’ ability to negotiate lower drug prices, adding extra pressure on top of Georgia’s legislation on reporting rules, Gassaway said. CVS Health released new findings Friday showing its commercial clients saw a 34% “negative trend” in drug spending last year.
The national PBM trade group Pharmaceutical Care Management Association estimates drug prices in Georgia could increase by $7.3 billion over the next decade due to last year’s legislation, arguing the reporting rules and other practice limits do not reduce the costs of prescription drugs.
“It’s unfortunate, especially for patients, that special interests like drug manufacturers and independent pharmacies backed the legislation, putting their profits before patient health,” said Greg Lopes, an assistant vice president for the association.
Amid concerns from some PBMs, Reybold said he does not buy arguments that Georgia’s recent legislation would lead to higher drug prices. He’s confident tighter reporting will pay dividends and keep many PBMs in better check.
“If they could keep everything trade-secreted, that’s what they will do,” Reybold said. “They’ve monetized every step of the way.”
ATLANTA – Commuters to downtown and Midtown Atlanta from Bartow, Cherokee and North Cobb counties will have a new way to get to work starting Monday.
Officials from The ATL, metro Atlanta’s regional transit planning and governance agency, cut the ribbon Friday on a park-and-ride lot that will service two new Xpress bus routes. The ATL oversees the commuter bus system.
The routes will use the Northwest Corridor managed lanes on Interstate 75, allowing passengers the advantage of less traffic without having to pay tolls.
“We want to provide area residents a new commuter option,” Chris Tomlinson, The ATL’s executive director, said shortly before cutting the ribbon at the new park-and-ride lot on Hickory Grove Road in Acworth.
Xpress ridership has declined during the coronavirus pandemic with so many workers staying home. But more than a year into the COVID-19 outbreak, the traffic load on the Atlanta region’s interstate highways is nearly back to pre-pandemic levels.
“We are seeing the roads open back up,” The ATL board Chairman Charlie Sutlive said. “The timing of [the new routes] really works well.”
The Hickory Grove Park & Ride Lot features 522 general parking spaces and 11 handicapped parking spaces. Four spaces have been set aside as future electric-vehicle charging stations.
The facility also has three bus shelters, four seating benches and six leaning benches.
The Xpress buses feature WiFi and a ventilation system designed to neutralize viruses.
Tomlinson said the two new bus routes will be free of charge during the first four months of operation.
With the addition of the routes, the Xpress system will operate 29 commuter routes in 12 metro-Atlanta counties connecting suburban and exurban commuters with major job centers in downtown Atlanta, Midtown Atlanta and the Perimeter Center.
Marking his 100th day in office, President Joe Biden swung through metro Atlanta Thursday to highlight Georgia’s pivotal role in securing his election and easing passage of his legislative priorities.
Biden, the first Democratic presidential nominee to carry Georgia since 1992, spoke at a drive-in rally in Duluth where he pressed for support to hike taxes on high-wage earners and corporations, plus national legislation to curb some impacts from Georgia’s recent controversial voting law changes.
Biden was joined by First Lady Jill Biden and several Georgia leaders at the Duluth stop including U.S. Sens. Raphael Warnock and Jon Ossoff, whose wins in January handed Democrats control of the White House and Congress.
“We owe special thanks to the people of Georgia,” the president said at Thursday’s rally. “Because of your two senators, the rest of America was able to get the help they deserved.”
The Bidens also paid a visit Thursday to former President Jimmy Carter and his wife, Rosalynn, at their home in Plains. Carter was among many high-profile Georgia Democrats to endorse Biden in last year’s general election.
Georgia’s Republican-led election bill capped a wide-ranging speech Thursday that touched on the Biden administration’s COVID-19 vaccine rollout, emergency pandemic aid, a proposed $2.3 trillion infrastructure plan and a child tax credit for lower and middle-class families that would be funded by higher taxes on the country’s wealthy.
Biden, who recently called the election bill “Jim Crow in the 21st century,” urged backing for two national measures that would reverse some changes to mail-in and early voting rules by broadening access to mail-in and early voting and reviving oversight provisions in the 1965 Voting Rights Act.
“If we are truly to heal the soul of America … we need to protect the sacred right to vote,” Biden said. “Your vote changed the world, but instead of celebrating that, it’s being attacked.”
The Georgia bill, which Gov. Brian Kemp signed last month after party-line approval in the General Assembly, requires tighter absentee voter identification, empowers state officials to take over poor-performing county election boards, expands early-voting weekend hours and bans non-poll workers from handing out food and drinks within 150 feet of voters waiting in line outside precincts.
Republicans have defended Georgia’s election bill as needed to boost confidence in Georgia’s election system amid former President Donald Trump’s claims of voter fraud, which state election officials and federal courts repeatedly rejected.
Kemp, who faces a possible rematch against Democrat Stacey Abrams in 2022, slammed the national voting legislation Democrats are now pushing as “an unconstitutional power grab.”
“This is their insane agenda, and they’re using lies, boycotts and cancel culture to ram it through,” Kemp said on social media Thursday. “I’ll continue to fight for secure, accessible elections.”
Biden also used his speech to tout the distribution of more than 220 million COVID-19 vaccines since his inauguration, passage last month of a $1.9 trillion COVID-19 relief package and new federal hate-crimes penalties that he touched on Wednesday night in his first address before a joint session of Congress.
Biden’s visit Thursday was his second trip to the Peach State since taking office. He appeared with Vice President Kamala Harris in Atlanta on March 19 to show support for the Asian-American community days after mass shootings at local spas killed eight people, mostly Asian-American women.
ATLANTA – First-time unemployment claims in Georgia fell last week, mirroring a nationwide trend as more Americans thrown out of work by the coronavirus pandemic get back on the job.
Jobless Georgians filed 28,764 initial unemployment claims last week, down 3,617 from the week before, the state Department of Labor reported Thursday.
Meanwhile, the labor department announced that 99.4% of all eligible claimants whose benefit year began in March of last year and who have requested payment have received a payment.
“We are getting almost 80% of all eligible payments paid in 21 days or less during a pandemic,” Georgia Commissioner of Labor Mark Butler said Thursday. “ That has been no small feat.”
By another measure, the agency paid 63% of eligible claims within seven days last month, well above the national average of 43% for March.
Claimants still waiting on a payment may include those who need to prove their identity or are involved in a fraud investigation. Other unpaid claimants may be providing additional information for employer or wage verification or waiting on an eligibility review.
The labor department has paid out more than $21 billion in state and federal unemployment benefits since COVID-19 struck Georgia in March of last year. The agency has processed more than 4.7 million first-time jobless claims during that time, more than during the last nine years combined prior to the pandemic.
The job sector accounting for the most initial unemployment claims in Georgia last week was accommodation and food services with 7,597 claims. The administrative and support services sector was a distant second with 2,483 claims, following by retail trade with 2,165.
More than 241,000 jobs are listed on EmployGeorgia for Georgians to access. The labor department offers online resources for finding a job, building a resume, and assisting with other reemployment needs.
ATLANTA – The Georgians most likely to benefit from Medicaid expansion are the same low-income workers who have done the most to prop up the state’s economy during the coronavirus pandemic.
That’s the conclusion of a new report from the Georgetown University Center for Children and Families.
Georgia is one of 12 states that has not expanded Medicaid coverage during the decade since a Democrat-controlled Congress passed the Affordable Care Act.
Expanding the joint state-federal health insurance program to Georgians with incomes up to 138% of the federal poverty level would add about 452,600 uninsured adults to the Medicaid rolls, according to the report.
Those newly enrolled would include the cashiers, cooks, maids, waiters and construction workers who have been forced to go to work every day during the pandemic while those in other professions have been able to work from home.
“Expanding Medicaid to Georgia workers is a powerful way to thank them for the work they did to keep our state’s economy moving over the last year,” said Laura Colbert, executive director of the nonprofit Georgians for a Healthy Future.
While Colbert’s group and others have pushed for Medicaid expansion in Georgia for years, supporters say the $1.9 trillion American Rescue Plan President Joe Biden signed into law last month includes new incentives for states that have not expanded Medicaid.
According to the Georgetown report, Georgia would gain an estimated $710 million in federal funds beyond the costs of the expansion, a net savings that could be used for other purposes including education, public safety and/or workforce development.
“Covering low-income, uninsured Georgians through Medicaid was already a good idea for our state,” Colbert said. “The new incentive makes it a deal too good to pass up, especially for struggling rural communities.
Indeed, earlier research conducted by Georgetown concluded Medicaid expansion would particularly benefit Georgia’s rural counties. The nine counties with the highest uninsured rates for workers are rural, led by Atkinson and Wheeler counties with uninsured rates of 35.1%.
Both Republican Gov. Brian Kemp and GOP predecessor Nathan Deal have opposed expanding Medicaid in Georgia through the Affordable Care Act. Kemp and other opponents have warned there’s no guarantee the federal funding would continue to flow after the first two years of Medicaid expansion.
Kyle Wingfield, president and CEO of the Georgia Public Policy Foundation, said the total price tag of the American Rescue Plan and other COVID-19 relief legislation Congress has passed during the last year will add up to an astounding $6 trillion during the next 10 years.
“At some point, the federal government is not going to keep up with its obligations,” he said. “We can reasonably expect the state’s portion of that [Medicaid expansion] burden will be even higher than advertised.”
Kemp applied last year for a federal waiver providing a partial expansion of the program covering adults earning up to 100% of the federal poverty level.
The federal Centers for Medicare and Medicaid Services approved the waiver last October. But after Biden took office, the new administration withdrew the approval, citing work requirements included in the waiver.