Drug price transparency could return as top legislative issue

ATLANTA – Drug prices and who controls them could be back before the General Assembly this winter, as consumer advocates and pharmacy benefit managers remain at odds over issues such as drug price transparency.

Gov. Brian Kemp signed legislation last year tightening rules on third-party companies that play a role in negotiating pharmaceutical drug prices between insurers and local pharmacies in Georgia.

The bill Kemp signed into law requires companies called pharmacy benefits managers (PBMs) to set drug prices within a national average, a move aimed at reining in excessively high prescription prices.

PBMs act as go-betweens for prescribers and insurance companies that contract with health insurers to negotiate lower drug prices for patients. But critics have long accused them of muddying the process, prompting increases in drug prices and delays in filling prescriptions.

Now, pharmacies such as CVS are worried Georgia lawmakers, when they reconvene in January, may take further action on drug pricing.

> Georgia prescription-drug price rules tightening draws concern, praise

“We are aware of efforts by some legislators to further explore drug pricing transparency,” said Leanne Gassaway, vice president of state government affairs at CVS Health. “Given the state’s enactment of PBM-related legislation nearly every year over the past decade, we would welcome the legislature to closely examine drug manufacturers’ role in drug pricing, including a notable lack of transparency in setting and increasing list prices.”

Ryan Hamilton, an associate professor at Emory Goizueta Business School, said price transparency typically causes drug prices to fall.

“The easier it is for customers to acquire price information, the greater the need for manufacturers to compete,” he said. “But the prescription pharmaceutical industry in the U.S. is so heavily regulated, those general rules may not apply.”

> Rules on prescription drug prices tightened in Kemp-signed bill

Hamilton said PBMs serve as an interface between drug manufacturers and pharmacies.

“Any measures to cut out middlemen from the equation are naturally going to cause protests,” he said.

“PBMs support and practice actionable transparency that enables patients, their physicians, and health plan sponsors in Georgia to make informed decisions on how best to manage prescription drug costs and empowers Georgia’s policymakers with the information they need to make the right policy decisions to lower drug costs for all patients,” said the Pharmaceutical Care Management Association, an organization which represents PBMs. “In Georgia, PBMs will save health plan sponsors and patients nearly $30 billion on prescription drug costs.”

Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up again in January.

“Discussions over PBMs have been going on for several years, and the legislature seems pretty fired up over continuing that effort,” Colbert said, explaining that PBMs were formed to help health insurers negotiate better deals with pharmaceutical manufacturers, and then pass those savings along to consumers.

“But realistically, it’s hard to know if those savings are actually being passed along,” Colbert said. “Pharmacies and health insurers are buying up PBMs, and it’s become especially hard to see where savings are being accumulated.”

One bill that will definitely carry over into January is House Bill 164, entitled the Prescription Drug Consumer Financial Protection Act. It would require health insurers to pass along no less than 80% of all prescription drug rebates to their enrollees.

“That 80% is consistent with what the Affordable Care Act requires,” Colbert said.

“We’ve been having some very fruitful discussions and we’re anticipating a very active legislative session,” said Gassaway, who is tackling a tough public relations challenge: convincing lawmakers and their constituents that making drug prices openly and readily available to the general public will, in fact, lead to higher drug prices.

“If we just put the prices out in the public domain, that information will be used to further manipulate the market,” she said. “We are not opposed to showing our clients how much we save them on drugs. We try to push that price down but putting a specific discount out into the public domain will only cause prices to rise.

“We have some other, great ideas on how to make that information available to patients in more useful ways.”

One of CVS Health’s ideas is making drug prices available, in real time, to doctors when they’re prescribing medications. “We have the ability to make that information available at the physicians’ fingertips, to determine the best prices,” Gassaway said. “That kind of information – such as cost-sharing alternatives – would be really helpful to patients.”

Gassaway touts CVS’ member-specific benefit information, which includes plan information, deductibles and other data that, the company said, lets health-care providers and CVS members know if a specific drug is covered as well as the member’s cost.

CVS said Georgia has some of the strictest PBM laws in the country. PBMs are now required to publicly report how close to a national average many health plans’ drug prices were negotiated. The state is also requiring PBMs to give state officials some confidential information on rebates and other negotiating tools.

PBMs are also now required to submit to new audits by the state Department of Community Health as well as requirements for publishing data on prescription prices online. They are also required to offer full rebates to health plans that are typically given by drug makers, rather than pocketing a portion.

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

Everything on the table, top Georgia senator says on abortion

ATLANTA – With the U.S. 11th Circuit Court of Appeals set to hold a hearing on Georgia’s abortion bill next Friday, a top Republican state senator said a Texas-style abortion bill could be introduced in next January’s legislative session.
“Everything is on the table,” Senate President Pro Tempore Butch Miller, R-Gainesville, told Capitol Beat Friday. “Our abortion law is being held up by the courts, but we’re confident it will be ultimately upheld. But my goal is to protect life, and we’re waiting to see what the courts say.”
Miller is also campaigning to be Georgia’s next lieutenant governor. Another GOP candidate for the post – state Sen. Burt Jones, R-Jackson – was recently endorsed by former President Donald Trump.
Georgia’s abortion bill – HB 481, known as the Living Infants Fairness Equality Act – seeks to prevent abortions after a fetal heartbeat has been detected, typically six weeks, except in special situations. Lawsuits brought by the American Civil Liberties Union, Planned Parenthood and the Center for Reproductive Rights eventually led the U.S. District Court for the Northern District of Georgia to rule the law unconstitutional.
“We’ve been working with organizations such as the Georgia Life Alliance, and we’ll see what the courts say,” said Miller.
Earlier this week, in a virtual press conference, Georgia Democrats specifically expressed their concern that a Texas-style abortion bill could soon be introduced in the state.
“What happens in Texas won’t stay in Texas,” said state Rep. Beth Moore, D-Peachtree Corners. “Not every pregnancy is an immaculate conception or a Hollywood-produced drama. There is a limit to what government can impose, and the Republican Party wants to replace God with government.”
Like the Georgia bill, the Texas law prohibits abortions once medical professionals can detect cardiac activity, usually around six weeks. The Texas law leaves enforcement to private citizens through civil lawsuits instead of criminal prosecutors.
If the 11th Circuit agrees with the district judge, Georgia could then appeal to the U.S. Supreme Court, which may then look at the law’s constitutionality and reexamine the precedent of Roe v. Wade.
Gov. Brian Kemp also is expected to call a special legislative session, likely in November, to redraw the state’s congressional and legislative districts under newly released U.S. Census figures.
“It has been suggested that while we’re in session, we could consider other measures, such as a Texas-modeled abortion law,” Moore said.
U.S. Rep. Nikema Williams, D-Atlanta, said special legislative sessions are called for a specific purpose – such as redistricting – but a two-thirds majority vote of the General Assembly could expand its originally called purpose.
This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

Georgia’s Carr joins 23 state AGs, threatening legal action over Biden COVID mandates

Georgia Attorney General Chris Carr

ATLANTA – Georgia Attorney General Chris Carr has joined 23 other state attorneys general in a letter to President Joe Biden warning of legal action if the White House’s proposed COVID-19 vaccine mandate is implemented.

“On Sept. 9, you announced that you would be ordering the Department of Labor to issue an emergency temporary standard, under the Occupational Safety and Health (OSH) Act, which would mandate that private sector employers either get a COVID-19 shot, submit to weekly testing, or be fired,” the letter said.

“Your plan is disastrous and counterproductive. From a policy perspective, this edict is unlikely to win hearts and minds – it will simply drive further skepticism.”

Also signing the letter were the attorneys general of Alabama, Alaska, Arizona, Arkansas, Florida, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, and Wyoming.

Read the full letter here.

Carr and the attorneys general also said Biden’s proposals threaten the nation’s job market.

“At least some Americans will simply leave the job market instead of complying,” they said. “This will further strain an already-too-tight labor market, burdening companies and (therefore) threatening the jobs of even those who have received a vaccine.

“Worse still, many of those who decide to leave their jobs rather than follow your directive will be essential healthcare workers,” the letter continued.

The letter also said Biden’s edict is “illegal. You proposed to enforce your mandate through the rarely used emergency temporary standard provision in the OSH Act. An emergency temporary standard does not have to go through notice and comment and can be made effective immediately upon publication. Because of this lack of process and oversight, courts have viewed these standards with suspicion.”

Gov. Brian Kemp has already signaled he will use whatever legal forces are available to block Biden’s proposal.

“Look, the public already doesn’t trust the federal government because of the mixed messages about the coronavirus,” Kemp told Capitol Beat on Sept. 10. “This is pandemic politics from a president who promised to unite the country, but instead is dividing us.”

“The vaccines have helped protect millions of Americans, and there are surely others who could benefit from obtaining this treatment” the letter concludes. “But convincing those who are hesitant to do so would require you to allow room for discussion and disagreement. Instead, you have offered the American people flimsy legal arguments, contradictory statements, and threatening directives. It is almost as if your goal is to sow division and distrust, rather than promote unity and the public’s health.

“We thus urge you to reconsider your unlawful and harmful plan and allow people to make their own decisions. If your administration does not alter its course, the undersigned state attorneys general will seek every available option to hold you accountable and uphold the rule of law.”

Speaking from the White House last week, Biden said the estimated 80 million Americans who have not been vaccinated have made COVID-19 “a pandemic of the unvaccinated. 

“And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot.”

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation

Raffensperger signs citizen-only voting petition

ATLANTA – Georgia Secretary of State Brad Raffensperger signed a petition Thursday supporting a Georgia constitutional amendment that would limit voting in state and local elections to American citizens.

“This measure has the overwhelming bipartisan support of the American people,” Raffensperger said. “Voting is a sacred responsibility for American citizens, and everyone should agree that only American citizens should vote.”

Raffensperger signed the petition during a news conference at the state Capitol hosted by Americans for Citizen Voting, a non-partisan nonprofit.

“From Maine to California, and everywhere in between including Clarkston, Ga., there is a growing movement in this country to permit non-citizens with green cards to vote legally in our elections,” said the organization’s president, Christopher Arps. “Voting is a sacred right of citizenship and it must be strictly reserved for citizens and citizens only.”

Georgia’s Constitution allows U.S. citizens to vote but, according to the organization, does not prevent non-citizens from voting as well.

The organization said Arizona and Minnesota have precluded non-citizens from voting for years, while Alabama, Colorado, Florida and North Dakota have recently passed amendments to provide only U.S. citizens are allowed to vote in local, state and school board elections.

Christopher Bruce, policy director for the American Civil Liberties Union of Georgia, said, “It is already the law that only U.S. citizens can vote in Georgia. It is irresponsible to perpetuate falsehoods about the integrity of elections in Georgia and undermines confidence in our democracy.”

Former President Donald Trump has endorsed U.S. Rep. Jody Hice, R-Greensboro, in his campaign to unseat Raffensperger next year.

According to widespread reports, Trump was angry at Raffensperger for his refusal to overturn last year’s Georgia presidential election results, in which Joe Biden carried Georgia by less than 1%. Biden’s victory in Georgia was the first time since Bill Clinton’s 1992 victory that a Democrat carried the Peach State in a White House contest.

The secretary of state denied his support of the measure is designed to win back any disgruntled Trump supporters, and said he has been a longtime advocate of citizen-only voting measures.

“I’ve been a Republican all my life,” Raffensperger said. “When I was in the legislature, I sponsored a bill allowing only U.S. citizens to sit on local boards. That bill died in the state Senate.”

A constitutional amendment to clarify that only U.S. citizens are allowed to vote in Georgia would need to pass both the state House and Senate by a two-thirds majority, and then be approved by a majority of Georgia voters during the 2022 general election.

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

Delivery of monoclonal treatments changed in Georgia

Coronavirus has sickened hundreds of thousands people and killed thousands more in Georgia. (Image: Centers for Disease Control and Prevention)

ATLANTA – The federal government has changed the way COVID-19 monoclonal antibody treatments are being distributed in the United States, including Georgia.

The U.S. Department of Health and Human Services (HHS) said this week the decision comes from supply shortages and demand for the treatments across the country, mainly due to the delta variant’s rapid spread.

Health-care providers will no longer be able to order the treatments directly. HHS said it will determine each state’s weekly allocation of monoclonal antibody products based on use and the number of new COVID cases.

The Georgia Department of Public Health said it will identify which sites in the state will receive the product and the amount each site receives.

Health-care providers must record their administration of the products in order to be eligible to receive additional shipments.

On Tuesday, Dr. R. Chris Rustin, director of the department’s Division of Health Protection, told a virtual Board of Public Health meeting preliminary data shows monoclonal antibody therapy is effective mostly early in treatment.

“You have to get it early on,” said Rustin, who added the state Department of Public Health is collaborating with the Department of Community Health to support the existing, 136 sites across the state. “It’s important to stress this is not a substitute for vaccines,” Rustin said.

Monoclonal antibodies are synthetic, laboratory-created antibodies. They help people at high risk for severe COVID illness, individuals who have tested positive for the virus within the last 10 days, or people who are close contacts of persons who have tested positive for COVID.

“We have safe and highly effective vaccines to protect against COVID-19. It is much easier to get a vaccine than risk becoming seriously ill with life threatening complications,” said Dr. Kathleen Toomey, the agency’s commissioner.

“Monoclonal antibodies are in short supply and high demand and hospital beds are full. What Georgia does have is enough vaccine for all Georgians aged 12 and over to be vaccinated.”

As of Wednesday, 53% of Georgians have received at least one dose of COVID vaccine and 46% of Georgians are fully vaccinated.

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.