Despite positive steps in prescription drugs provisions, transparency, clarity is needed

For many people the rising cost of prescription medication has caused them to make many tough decisions between the drugs that help keep them healthy and other living expenses they must pay.

Provisions in the Inflation Reduction Act are expected to bring costs down for the consumers. But smaller local, independent pharmacies worry where the burden of the consumer will shift as the law rolls out.

From 1980 to 2018 the per capita spending on prescription drugs increase sevenfold from $140 to $1,073 when adjusted for inflation, according to The Peter G. Peterson Foundation, a nonpartisan financial policy organization.

In a 2018 GoodRX survey more than 40% of Americans struggle paying for the cost of their medication with a third of Americans saying they skipped filling prescriptions because of cost.

Victoria resident Rene Rosales, 53, struggles to pay for his medication. He is forced to make tough decisions between paying for the medication that keeps him healthy and buying food.

Rosales has a digestive condition that without his medication causes him such physical pain that he can't work. This makes affording the medication difficult when he runs out or he experiences issues from his condition, Rosales said.

In times like this he and others in a similar situation go to local nonprofits such Christ's Kitchen, First United Methodist Church and Victoria Christian Assistance Ministry, which provide aid to people struggling with non-narcotic prescription drug costs.

Christ's Kitchen, where Rosales seeks assistance, is able to do this through donations to the program. The soup kitchen has a standing account with Harding & Parker Drug Store, Trish Hastings, Christ's Kitchen executive director, said.

Many of the people who come through Christ's Kitchen struggle to pay for critical drugs such as insulin, blood pressure medication and others, Hastings said.

The organization's account with Harding and Parker can often get into the thousands of dollars, she said. So bringing Medicare to the negotiating table and setting a cap for medication for out-of-pocket Medicare Part D enrollees, will be a big deal among the people she works with, she said. She noted setting a co-pay cap on insulin at $35 a month should be a big help.

"I'm thrilled and so will our people be," Hastings said.

As an example, she spoke of a client who had a prescription for insulin that cost $403. She and the pharmacist called the client's doctor and was able to get a less expensive prescription, but she is concerned the lesser expensive insulin may not be the strength the client needs. She is hopeful the cap will help solve this type of situations.

"This is huge for our community members and we're going to need to get the word out," Hastings said.

While the benefit to the consumer is great, local pharmacists still have remaining questions about how the Inflation Reduction Act will affect them.

Often times insurance providers won't pay enough to cover the cost of acquiring the drug for the pharmacy, said John Rogers, Rogers Pharmacy manager.

This is because of how drug prices are negotiated by pharmaceutical benefit managers, a third party negotiator that negotiates drug prices between the drug manufacture, the pharmacy and the customers' insurance, Rogers said. This creates an environment that lacks transparency in pricing and presents challenges for local pharmacies to stay competitive.

In some cases these negotiators are owned by insurance companies or pharmacies such as United Health with Optum RX or CVS Health which owns CVS Caremark.

"If I buy a drug for $500 and dispense it to you and your insurance is only going to pay me $490. I'm getting paid less than I can buy the drugs for," Rogers said.

This is particularly challenging if the insurance company insists on expensive brand medications, he said.

"This industry is very complicated and nontransparent," Rogers said.

He is uncertain how introducing Medicare as a negotiator will affect the market as it was already contracting with these pharmaceutical benefit managers to negotiate for Medicare Part D but he is hopeful, he said.

"It's slowly but surely going to be transparent because they are going to cut that middle man, go around (pharmaceutical benefit managers) and negotiate straight with the manufacturer," Rogers said.

However, more needs to be done to bring transparency to market because costs of drugs just keep getting inflated further each year as the pharmaceutical benefit managers get more and more of a cut from negotiations, he said.

Rogers credited Texas Sen. Lois Kolkhorst, R-Brenham, for her efforts to make the process more transparent on the state level in the last legislative session. She introduced a bill, S.B. 528, which was the sister bill to House Bill 1763, that helped bring competitive balance for pharmacies by imposing regulations on pharmaceutical benefit managers after it was signed into law by Gov. Greg Abbott.

Other area pharmacists shared Rogers' concerns and hopes, noting that while the thought behind the prescription drug provisions is great they won't know how it will affect them until the bill is fully implemented as new legislation tends to favor larger national pharmacies.

Provisions within the Inflation Reduction Act regarding prescription drug costs will begin rolling out in 2023 and will be implemented through the next decade, according to the Kaiser Family Foundation, a nonprofit healthcare policy organization.

"As I understand this right now, it looks amazing as far as prescription drugs are concerned, but we need more clarification for the layman so someone like me can understand what's going on so I can impart that information to our community," Hastings said.