Supporting Real Solutions for Affordability and Access

The Cures for the Commonwealth campaign is committed to supporting real solutions for affordability and access to medicines for patients suffering from rare and serious illnesses.

Through this effort, members of the campaign were successful in helping extend the Massachusetts Prescription Drug Assistance Law in 2022 to maintain patient access to prescription drug assistance programs that significantly reduce out-of-pocket expenses at the pharmacy counter. In addition, the campaign joined with other patient advocates from across Massachusetts to pass legislation limiting the use of step therapy, which ensures access to critical medications and treatments for those who need them.

For the 2023-2024 legislative session, we are supporting additional policies that will decrease out-of-pocket costs for consumers and increase transparency in the pharmaceutical industry:

HD.851/SD.1755, An Act relative to promoting healthcare access and affordability for patients.

In Massachusetts alone during 2019, pharmaceutical companies rebated more than $2.5 billion back to health insurance companies and pharmacy benefit managers (PBMs) – money that should be shared with customers and provide savings at the pharmacy counter.

Instead, these rebates become profits for health insurance companies and the PBM middlemen. An Act Relative to promoting healthcare access and affordability for patients would tackle this problem by requiring health care plans to pass at least 80% of rebates received from pharmaceutical companies on covered drug products to patients in the form of lower copayments at the pharmacy counter.

HD.851/SD.1755, An Act relative to promoting healthcare access and affordability for patients.

Proposals designed to provide meaningful benefits for patients in terms of lower out-of-pocket costs at the pharmacy counter need to be reasonably tailored to address all pieces of the drug supply chain, including payers and PBMs.   An Act relative to promoting comprehensive transparency in the pharmaceutical industry would do just that by creating a broad and thorough review of drug pricing.  It holds manufacturers accountable for significant price increases through mandated transparency disclosures and, since we know that focusing on manufacturers alone ignores other key drivers of costs in the drug supply chain, the legislation also gives regulators new transparency authority over PBMs.

When it comes to PBMs, for too long the role that they play in what patients ultimately pay for medications has gone unchecked in Massachusetts. The actions of these industry middlemen – who often markup drugs before they are sold –  have been described by the Massachusetts Health Policy Commission as a “black box”  because of their lack of transparency and potential contributions to high drug costs. Other states, like Texas, have passed legislation increasing reporting requirements on PBM’s and have subsequently found startling evidence of just how little of manufacturers’ rebates are passed on directly to patients to lower their out-of-pocket costs. This legislation aims to join these other states by giving Massachusetts regulators new transparency authority over PBMs to shed more light on the “black box” of PBM profits and business practices.

TAKE ACTION: Ask your legislators to stand with patients and co-sponsor these critical pieces of legislation to decrease costs for consumers and increase transparency for the middlemen.