By Edward Henderson | California Black Media
Sen. Scott Wiener (D-San Francisco) has introduced two bills in the State Senate that could lower prescription drug prices for California residents.
Senate Bill (SB) 40, or the Insulin Affordability Act — and accompanying legislation, SB 41, or Pharmacy Benefit Manager (PBM) Reform — comprise Wiener’s Prescription Drug Affordability (PDA) Package.
Together, the bills would cap monthly co-pays for insulin at $35 (SB 40) and create regulations for pharmacy benefit managers (PBM) whose negotiation practices, critics say, have resulted in steep price increases for prescription drugs (SB 41).
“It makes no sense that people with diabetes in states like West Virginia can access affordable insulin while Californians are stuck with higher prices,” said Wiener in a statement.
“When basic life necessities like medication become unaffordable in Blue States, working people pay the price. As Democrats, we should be leading on making people’s lives better and more affordable,” continued Weiner. It is past time California caught up with other states and put basic protections in place to contain the astronomical cost of basic medications.”
SB 40’s proposed $35 monthly co-pay was written, in part, in response to the price of insulin tripling over the past decade, Wiener’s office says. As a result of the increase, one in four people using insulin has reported insulin underuse because they can’t afford the full dose. Four in five Americans in need of insulin have incurred thousands of dollars in credit card debt to pay for the medication, according to a recent survey conducted by CharityRx.
About 4,037,000 adult Californians have diabetes, with an additional 263,000 cases of Type 1diabetes diagnosed each year. This rate in new cases disproportionately affects the elderly, men, and low-income patients, Wiener’s office reports.
Christine Fallabel, regional director of state government affairs and advocacy with the American Diabetes Association (ADA), a sponsor of SB 40, said, “The ADA has long led the fight to make insulin more affordable, and there has been significant progress. We look forward to building on the momentum across the country to extend the $35 per month insulin cap to include people with state-regulated health plans in California. No one should have to skip their lifesaving insulin due to costs alone.”
According to Wiener, SB 41 is his follow-up to similar legislation he introduced last year, SB 966, which was vetoed by Gov. Newsom.
Middlemen in the pharmaceutical industry, PBMs buy prescription drugs from manufacturers and then sell them to pharmacies and health plans. Their position as intermediaries allows them to charge high administrative fees and significantly higher prices for drugs to pharmacies than they paid originally. This practice results in higher costs for patients seeking the prescriptions they need.
“On behalf of the Californians we serve who live with chronic and rare diseases, we are grateful to Sen. Wiener for his commitment and attempt to hold pharmacy middlemen accountable for their anti-patient and anti-pharmacy practices,” statedLiz Helms, California Chronic Care Coalition President & CEO. “Health care costs continue to rise when patients cannot afford medically necessary medications. We are committed to bringing transparency and oversight to PBMs, and look forward to continuing our work with Senator Wiener, our advocacy partners, and welcome others to join us in this fight.”
SB 41 proposes that all PBMs be licensed and that they disclose basic information regarding their business practices to the licensing entity. It also calls for a number of other requirements and prohibitions, including limiting how fees may be charged and requiring transparency related to all fees assessed.
“This bill addresses some of the worst abuses by pharmacy benefit managers: lack of transparency, unfair business practices, steering, and price gouging,” said Jamie Court, President of Consumer Watchdog. “Increasingly what is best for PBMs is not best for patients or the health care system.”
In 2022, drug spending in California grew by 12%, while total health premiums rose by just 4%. Last year, more than half of Californians either skipped or postponed mental and physical healthcare due to cost, putting their safety and well-being at risk. One in three reported holding medical debt, including half of low-income Californians.
So far, there is no organized opposition to the Prescription Drug Affordability package.
