New York must rein in health care costs

This won’t come as a surprise to many, but one of the biggest issues facing the Americans my group serves is the rising cost of health care. And while state and federal lawmakers work to unravel the complicated and often opaque costs behind what patients pay, this problem can’t be solved by focusing on singular parts of the health care universe. There are several drivers of cost, and each needs examination.

That is why it is disturbing that a state like New York is taking aim at one facet of the health care industry, while seemingly giving another a pass — a move that could impact all New York patients, but especially older New Yorkers living with chronic diseases.

Two provisions up for debate in the 2023 budget would not only do little to help patients pay less for medications, they could also stifle the very industry that gives Americans living with chronic illnesses a shot at a better future.

The Prescription Drug Price and Supply Chain Transparency Act of 2023 in the budgets proposed by Gov. Kathy Hochul and the State Senate would impose stiff regulations on the biopharmaceutical industry, to the point that future innovations could be put at risk.

How? The proposal includes overreaching requirements for pharmaceutical manufacturers to report on even the slightest change to the price of a medication, impeding access to that medication for patients until the paperwork is deemed sufficient by the state Department of Financial Services. With all due respect to hardworking DFS employees, I wouldn’t want my cancer treatment or a new medication to treat my grandchild’s autoimmune disease delayed because of unnecessary red tape. Similar proposals in other states have landed in federal court. 

New York has not been shy about keeping tabs on pharmaceutical pricing — beyond what the federal government requires. In 2020, the state passed legislation that gave DFS power to investigate prescription drug price jumps. 

Additionally, proposals to regulate patent settlement agreements will do the opposite of their intent — getting cheaper treatments to patients in a timelier manner. Inserting New York into areas clearly governed by the federal government, specifically the Federal Trade Commission, will slow down access to generics and biosimilars, drugs based on an original patented medication that can be produced at a lower cost once a patent expires. This is wildly unnecessary and a perfect example of unnecessary governmental creep. 

While these proposals may seem misguided, where is the scrutiny on the insurance industry's pharmacy benefit managers or PBMs? Patient and health care groups for years have been playing a game of whack-a-mole to pass legislation to push back against the latest PBM schemes. PBMs are known for finding ways to pad their bottom line — like keeping pharmacists from telling consumers they could pay less for a drug by not using their insurance, or refusing to apply third-party copay assistance to a patient's total out-of-pocket costs. New York lawmakers have rightly worked to fix these wrongs, but PBMs can’t be left out of a discussion on prescription drug costs.

Clearly, impeding scientific research and access to the latest innovative treatments is not the goal of Gov. Kathy Hochul or the State Senate. However, it’s not hard to see how quickly that could be the result. For patients across New York — especially the seniors my organization serves — leaders in Albany must quickly scrap these budget provisions and protect the health and well-being of patients across the state.