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6/26/2023
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Morales/Goodwin bill to lower prescription drug costs enacted
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STATE HOUSE – A bill introduced by Rep. David Morales and the late Sen. Maryellen Goodwin to limit the out-of-pocket expenses of specialty prescription drugs is now law. The bill caps the out-of-pocket costs for specialty drugs to $150 per 30-day supply. Protections would kick in once the patient reaches their deductible.
“With over 6,000 of our neighbors battling cancer and many others relying on specialty drugs to stay alive, it is the responsibility of our state government to ensure that all people, regardless of socioeconomic status, can afford these lifesaving medications. Unfortunately, these treatments typically cost thousands of dollars each month as pharmaceutical companies engage in monopolistic practices to increase and maximize their profits,” said Representative Morales (D-Dist. 7, Providence). “It is unconscionable that our working people, families and seniors are often forced to choose between paying their utility bills or paying for medications to keep their loved ones alive, so that a handful of pharmaceutical and private insurance companies can profit. Health care is a right and these lifesaving medications should be free. And while this bill does not get us there, lowering the cost of prescription specialty drugs is significant progress that will help thousands of Rhode Island families struggling with overwhelming medical bills.”
Prescribed specialty drugs are defined, priced and classified by Pharmacy Benefit Managers as complex oral or injectable medications used to treat chronic conditions, such as cancer, hemophilia and arthritis. Most specialty medications are lifesaving prescriptions that patients must take regularly for years. But even with insurance coverage, copayments can be as high as $2,500 per month, forcing some families to choose between saving the life of their loved one or financial ruin. A 2016 report from the AARP found that 25% of Rhode Island residents stopped taking their prescribed medications due to high costs.
The law (2023-S 0871A) caps out-of-pocket costs for such specialty drugs at $150 for a 30-day-supply for every private individual or group health insurance contract, plan or policy that provides prescription drug coverage and is delivered, issued for delivery or renewed on or after January 1, 2025. Patients would be required to meet their deductible before the price cap kicked in, but many people with chronic conditions meet their deductibles early in the year due to high medical costs, and will be on track to save thousands of dollars under this bill.
Senator Goodwin, who battled cancer for years, had championed the bill in the Senate. Representative Morales introduced companion legislation (2023-H 5350A) in the House.
“Senator Goodwin was always a strong advocate for quality, affordable health care,” said Senate President Dominick J. Ruggerio (D-Dist. 4, North Providence, Providence). “She would be proud we were able to get this done to support Rhode Island patients.”
Pharmaceutical companies often own the patents of specialty drugs, which give them a monopoly on these vital treatments. Consumers have no ability to negotiate prices or seek alternatives, allowing companies to charge higher rates each year. One glaring example is Revlimid, a medication used to treat cancer that was approved by the FDA in 2005. The medication originally cost $215 per pill. The company, Celgene, has raised the costs more than 20 times since, and one pill is now $878. In 2020, the U.S. House Committee on Oversight launched an investigation to understand these price increases and found that the increased costs were not due to research and development or modifications to the drug. Instead, they found, prices were raised in the pursuit of greater profit.
“Many patients living with cancer rely on these lifesaving drugs that cost $100,000 or more. In many cases, even patients with insurance spend thousands of dollars each year on their medicine. Lives are on the line. Nearly half of cancer patients taking oral chemotherapy stop when their out-of-pocket costs exceed $2,000. They simply can’t afford it. Rhode Islanders shouldn’t have to choose between food, housing, and lifesaving medications. With the passage of this bill, they won’t have to,” said Jen McGarry, Rhode Island Leukemia and Lymphoma Society Advocacy Director. “We’re grateful to Representative Morales, the late Senator Goodwin and the leadership at the General Assembly for their work.”
Rhode Island now joins states such as Delaware, Louisiana, New Jersey, California, and Maryland that cap out-of-pocket expenses for specialty medications at $150 per 30-day supply.
For more information, contact:
Fil Eden, Publicist
State House Room 20
Providence, RI 02903
401.222.1886
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