Guest: State lawmakers have chance to slash prescription costs for nearly 1M Oklahomans
Prescription drugs will get a lot cheaper for nearly a million Oklahomans under a new proposal before the Oklahoma Legislature.
Oklahoma House Bill 2853, more commonly known as "Share the Savings," may be one of the most important pieces of legislation state lawmakers consider this year. If passed, 983,000 Oklahomans paying for health insurance will see their out-of-pocket costs for prescriptions fall dramatically.
Here's why. Currently, prescription drug makers offer insurers and other payers discounts and rebates that equal about 40% of a medicine's list price. But nothing requires insurers to pass those savings on directly to patients at the pharmacy. Rather, insurers use them to fatten their own bottom line ― and that of their affiliated pharmacy benefit managers (PBMs), the entities that negotiate prices with drug makers for favorable positioning in a plan's coverage.
That's where patients get a twofold raw deal. First, the only savings they see from these discounts are a tiny reduction in monthly premiums they will notice barely, if at all. Worse, when patients are paying out of pocket for prescriptions, either because they're still in their deductible or have a coinsurance obligation, their responsibility is often based on the full price of the medicine ― even if the insurer is buying it at a discounted price. That's a rip-off, pure and simple.
Imagine a patient takes a medicine with a list price of $1,000 per month ― but their insurance company is only paying $500 for the drug after the discount the insurer receives from the pharmaceutical company. Say the patient's cost-sharing obligation is 20%. But insurers charge that 20% against the full list price. So, the patient pays $200 for each monthly refill, rather than $100 based on 20% of the price the insurer is actually paying. Needless to say, insurers don't inform patients about this subterfuge.
The Share the Savings bill would end such practices by requiring insurers to pass the savings they receive from pharmaceutical companies along to patients at the pharmacy. Some Oklahomans filling prescriptions would see savings of up to $1,000 annually.
The benefits of this legislation, however, would extend further still. According to research by the U.S. Department of Health and Human Services, reducing out-of-pocket prescription expenses for patients could lead to health improvements that result in massive savings for taxpayers. When patients pay less for prescriptions, they are more likely to fill them and take them as directed. The resulting health outcomes lead to "reductions in downstream spending for hospitals and physicians."
Adhering to prescribed treatment regimens ensures that manageable conditions don't become costly, life-threatening health emergencies. I've met many people living with mental illness who struggle to take their medicines as directed because of the cost at the pharmacy. Share the Savings would make it easier for these individuals to live healthy, fulfilling lives.
In addition, the Share the Savings bill won't cost taxpayers a dime and will have very little impact on the cost of health insurance premiums. The estimated increase would be just 0.6% or less ― a paltry sum in comparison to the savings at the pharmacy counter when you actually need a medication.
Share the Savings bills are nothing new. West Virginia passed a version of the legislation in 2021, and similar proposals have been introduced in at least 15 states since 2022. And just this month, Arkansas' governor signed a Share the Savings bill into law.
In 2019, United Healthcare began a small Share the Savings program, and the results were telling: Patients saved an average of $130 per year and medication adherence improved up to 16%.
Given such gains, it's no surprise that 87% of Oklahomans support efforts like Share the Savings mandating that manufacturer discounts be passed on fully to patients.
More than four out of five Americans say the cost of prescription drugs is unreasonable. Oklahoma's state lawmakers have a unique opportunity to do something to lower that expense for almost a quarter of the people in the state. They can do so by passing Oklahoma House Bill 2853.
Lorna Palmer is the executive director of NAMI Oklahoma, the state organization of the National Alliance on Mental Illness.
This article originally appeared on Oklahoman: Lawmakers can cut prescription costs for nearly a million Oklahomans
