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« Activists challenge Georgia abortion ban, expand access in California. | Main | RWV speaks out while court debates ACA »

RWV roundup: Title X, Medicaid & high drug prices

Big win for prescription drug costs in Maine!

Maine’s governor has signed into law a comprehensive bill package to tackle high prescription drug costs.

Pictured above: Kate Ende, CACH Policy Director, 3rd from left; Ann Woloson, CACH Executive Director, 1st from right; Governor Mills at podium
Ann Woloson, Executive Director of Consumers for Affordable Health Care (our Maine-based regional coordinator), hailed the signing saying: “We are thrilled the Governor has signed all four bills in this important package of legislation.” Collectively, these bills give Maine people and policymakers a variety of powerful tools to help understand why drug prices are increasing and to bring down the soaring costs of lifesaving medicine.” She added: “Maine people are concerned about the high cost of prescription drugs, with two out of three worried about not being able to afford prescription drugs or medicine they need. This bill package takes a comprehensive approach to addressing these concerns.”

The four bills take a comprehensive approach to addressing high drug costs in Maine:

LD 1499, An Act to Establish the Maine Prescription Drug Affordability Board, establishes an independent Board that will develop spending targets for prescription drugs purchased by certain public payors.

LD 1162, An Act To Further Expand Drug Price Transparency, builds on legislation passed in the last legislative session that requires the Maine Health Data Organization (MHDO) to post a list of: the 25 most prescribed drugs; the 25 most expensive drugs; and the 25 drugs with highest cost increases in Maine.

In addition, LD 1162 requires drug manufacturers, drug distributors, and pharmacy benefits managers to provide pricing component data that must explain the cost of making the prescription drug available to consumers, including payments received (taking into account any price concessions), as determined by rules adopted by MHDO.

LD 1272, An Act to Increase Access to Low-cost Prescription Drugs (safe wholesale importation from Canada), establishes a wholesale importation program for certain prescription drugs from Canada, by or on behalf of the State, in order to provide cost savings to consumers.

LD 1504, An Act To Protect Consumers from Unfair Practices Related to Pharmacy Benefits Management, requires that compensation paid by, or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly to a carrier (insurer) or to a pharmacy benefits manager related to its prescription drug benefit must be paid directly to the covered person at the point of sale or to the carrier.

New study shows that Medicaid work requirements don’t work

A recent study showed work reporting requirements imposed on Medicaid recipients by the state of Arkansas led to significant losses in health insurance with no significant increase in employment.  The researchers, who are based at the Harvard T.H. Chan School of Public Health, surveyed nearly 6,000 people in Arkansas, Kentucky, Louisiana and Texas to determine whether they were employed, had private insurance or Medicaid coverage before and after June 2018, when the work reporting requirements went into effect.   In addition to comparing Arkansans to their neighbors, the study also surveyed people living in Arkansas who were outside the age range affected by the new requirements (ages 30 – 49).  In all comparisons, the people subject to the work reporting requirements did worse:  Medicaid coverage dropped from 70% to 64% and being uninsured increased from 10.5% to 14.5% while having insurance through an employer did not significantly increase

The new study provides the best evidence yet available about what happened to the 18,000 people who were dis-enrolled from Arkansas Medicaid in 2018 for failure to file monthly reports on their work or volunteer activities.  It also stands in stark contrast to administration officials’ claims that reporting requirements result in more people getting jobs with employer-provided health insurance.  

According to HHS Secretary Alex Azar in testimony before Congress in March, "Only 1,452 of those 18,000 people even reapplied for Medicaid" this year.  "That seems a fairly strong indication that the individuals who left the program were doing so because they got a job [in] this booming economy.  Shortly after Azar’s testimony, Center for Medicare and Medicaid Administrator Seema Verma (pictured below) issued a new guidance on how CMS will review and approve applications for Medicaid work requirements.  Verma has already approved work reporting requirements in seven states, and requests from seven more states are currently pending. 

Verma has made no secret of her ideological commitment to undermining Medicaid’s safety net by allowing states to make their own rules, stating that, “This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens.”  In Arkansas, Verma originally allowed the state to require Medicaid recipients to report on-line through website that was only available between 7am and 9pm.  The on-line reporting requirement was identified as a significant barrier in the Harvard study:  32% of the people surveyed who had been told by the state that they needed to report were not doing so because they had no internet access.  

Title X gag rule enforcement begins immediately

Trump administration officials announced earlier this week that they would immediately begin enforcing a new rule that prohibits federally-funded family planning clinics from providing their clients with referrals for abortion care.  The prohibition on abortion referrals is part of a sweeping change to the Title X program, which was originally proposed by the Trump administration in 2018.  Planned Parenthood and some independent clinics have declared that they will withdraw from the program rather than comply with rules that put limits on the care they can provide to clients. Planned Parenthood has assured clients that their clinics will rely on emergency funds if necessary to stay open.

The Title X rules were adopted by the Trump administration in spite of a wave of opposition from professional organizations and individuals.  The new rules will likely force full-service clinics out of the program, and shift federal funds to religiously-affiliated clinics that oppose contraception.  In addition to the restrictions on referrals, the rules require any clinics that also provide abortion care to create a physically separate facility, a step that is medically unnecessary and very likely too expensive for most clinics to accomplish.  The new rules also do away with the long-standing requirement that federally-funded clinics offer a wide range of contraceptives and agree not to impose coercion of any kind on their clients’ choice of contraceptive method.  By doing away with that requirement, the administration has opened the door to facilities like the Obria Group, which teaches natural family planning and opposes contraception.  
The administration’s announcement that it would begin enforcing the new Title X rules came just a few days after a federal court of appeals ruling gave the government permission to activate the rules before the legal challenges have been fully decided.  Law suits challenging the rules have been filed by individual clinics, the association of federally-funded family planning clinics and twenty states.  The lawsuits are still working their way through the courts, but in the meantime, the administration is making it more difficult for people who depend on federally-funded clinics to get comprehensive care and information. 

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