Controversy around the more than 400 percent increase in the price of EpiPens is just the latest in a year filled with stories of dramatic drug price gouging. Indeed, health headlines have been dominated by everything from $84,000 for a 12-week course of treatment for Hepatitis C to a more than 5,000 percent increase in the price of Daraprim, a drug used primarily by people living with HIV/AIDS. Even older brand-name drugs and generic drugs have not been immune from significant price increases.
Despite the headlines—and congressional hearings, investigations, and proposed policy solutions—consumers are bearing the burden of high drug prices in the form of higher insurance premiums and cost-sharing. In 2015, nearly one-quarter—24 percent—of people taking prescription drugs reported having a difficult time affording their medication.
High out-of-pocket costs also impact patient health: consumers with higher drug cost-sharing are more likely to fail to start, to abandon, or to delay treatment. And many consumers take matters into their own hands by reducing the dosage and regularity of their drug intake, asking providers to prescribe less-expensive medications, or using alternative therapies to offset high out-of-pocket costs. Unsurprisingly, this reduced drug adherence can result in potentially worse health outcomes and higher health care costs.
Although much attention is focused on federal policy change to address high drug prices, many overlook the role that state policymakers play in protecting consumers from the effects of drug price gouging.
To highlight this role, a diverse group of patient and consumer advocates appointed to serve as consumer representatives to the National Association of Insurance Commissioners (NAIC) recently released a report on options for state regulators and policymakers to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage.
The report reflects the latest research and data on specific topics, such as drug cost-sharing, adverse tiering, health disparities, and value-based pricing, among many others. In particular, the report includes a set of recommendations and features examples of promising practices in a wide variety of states such as California, Massachusetts, Montana, Nevada, New York, Texas, and Vermont.
The findings suggest that state policymakers have significant flexibility and a variety of options to promote consumer access to prescription drugs in a way that meets the needs of their state. The report also shows that state legislators and insurance regulators can, do, and should continue to adopt policies that help provide consumers with the affordable prescription drugs they need.