Should a state panel control drug prices? Why some are arguing against it.

PROVIDENCE – It wasn't just pharmaceutical manufacturers warning Rhode Island's lawmakers last week about the potential consequences of trying to control drug costs, but also advocates for patients with rare conditions.

"Please do not take away the medications which keep my daughter alive," Christina Whatmough implored the Senate Committee on Health and Human Services. "My 22-year-old daughter has cystic fibrosis and without the advent of some of the most recent medications from pharmaceutical companies, she would be dead."

"We feel as though Rhode Island is wading into a policy territory that potentially poses an unintended risk to patient access," echoed Boomer Esiason, writing on behalf of what he described as "the Rhode Island cystic fibrosis community" as co-chair of the board of directors of Boomer Esiason Foundation.

Both were responding to the proposed creation of a Rhode Island Drug Cost Review Commission, which is one of the farthest-reaching pieces in a 25-bill healthcare package backed by Senate leadership this year.

What would a Drug Cost Review Commission do?

The Commission would review prescriptions drug costs and, if it finds that spending on the prescription drug "creates excess costs for payors and consumers," the Commission themselves can then set the reimbursement level that will be billed and paid to everyone in the supply chain, including pharmacists, wholesalers, distributors and uninsured consumers.

If those reimbursement levels aren't followed, instances "shall be referred to the office of the attorney general," the legislation reads.

The eight-page bill had its own enthusiastic backers, including the AARP, which noted that several states have already enacted similar legislation, including Maryland, Colorado, Washington, and Minnesota.

But it also prompted warnings, including those raised by the cystic fibrosis advocacy group about "prescription drug affordability review boards" that do "not address the true levers of affordability that govern healthcare costs for Americans, which are out-of-pocket costs."

"Eliminating out-of-pocket costs can meaningfully lower healthcare spending without compromising patients' access to lifesaving medications and overall wellbeing," the group argued. Drug pricing boards, they said, can "stifle drug development and threaten patients' access to lifesaving medications."

In its own letter of opposition, the Pharmaceutical Research and Manufacturers of America (PhRMA) said that, if the government sets drug prices, some prescription options could become limited for Rhode Island residents.

"If a pharmacy or provider cannot obtain a medicine at the government price, the medicine may not be available to Rhode Island residents," the group wrote. "By disincentivizing the development of innovative treatments, this legislation could [also] threaten the positive effect that the biopharmaceutical industry has on Rhode Island's economy."

Elaborating, the PhRMA letter questioned whether "the substantial rebates and discounts paid by pharmaceuticalmanufacturers" are actually offsetting patient costs at the pharmacy counter.

More: RI's health care system is 'in critical condition.' This bill package aims to stop the bleeding.

Other health care bills drew sharp opposition

It was not the only bill in the Senate's 25-bill healthcare package that elicited sharply opposing views during hearings last week.

The Rhode Island Medical Society − and a parade of doctors − enthusiastically backed legislation to give the Office of the Health Insurance Commissioner an expanded new role in developing and then phasing regional parity into the rates Rhode Island's private insurers pay doctors.

Beginning in 2028, Rhode Island reimbursement rates would be adjusted biennially to meet "a reimbursement rate floor," defined as the average of reimbursement rates in Connecticut and Massachusetts.

But Terrance Martiesian, the Rhode Island lobbyist for America's Health Insurance Plans (AHIP), warned the legislation would limit an insurer's "ability to negotiate competitive reimbursement rates and ... make health care unnecessarily more expensive for Rhode Island consumers and businesses, which ultimately may limit access to health care."

While praising the intent, the state's Acting Health Insurance Commissioner Cory King also sounded alarms.

While there is not a lot of data on how much more doctors in Massachusetts and Connecticut are paid, King said R.I. generally has lower health insurance premiums, in part, because of the "differences in [the] state economies."

As the legislation is written, he warned: "The regional rate parity framework will increase the health insurance premiums paid by individuals and small businesses in Rhode Island. It will also increase the cost of healthcare paid by self-funded employers, including the municipalities and the state employee health benefit plan."

This would create a cycle of insurers, facing higher provider prices, increasing their premiums to employers, who then pass that cost on to their workers, making health care ultimately more expensive for families, he explained.

As it stands, the average health insurance premium for a family plan was $22,955 in Rhode Island in 2022 − "nearly the average cost of a new compact car ($23,839)." He also noted: Rhode Island's median household income is approximately 14% lower in Massachusetts.

This article originally appeared on The Providence Journal: Could RI move to control prescription drug costs? What this bill would do.