Lawmakers Work To Get Drug Pricing, Mental Health Parity Over Finish Line
Posted to: Business, Consumer Protection, Corporate Watch, Health Care, Mental Health Care, Insurance, Transparency
HARTFORD, CT —With 20 working days left in the legislative session, lawmakers are making a big push for legislation that would improve mental health parity and make drug prices more transparent.
“This bill is a work in progress, but we feel like we’ve made a lot of progress,” Rep. Sean Scanlon, D-Guilford, said of a House bill that would increase transparency in drug pricing.
The co-chairman of the Insurance and Real Estate Committee said the bill is on the House calendar and “I think we’re getting close.”
He said they’ve been talking about the legislation since last year with all the various stakeholders and the legislation is bipartisan so its chances in a sharply divided House and Senate are much better than some other pieces of legislation.
The bill, according to Scanlon, would require drug companies to justify any drug price increase above 25 percent. The company would be required to report their response to the Office of Health Strategy. The bill also requires any Pharmacy Benefit Manager (PBM) to disclose the total amount of rebates received from manufacturers and how much of the rebate was retained. The third part of the bill would allow consumers to use a point-of-sale rebate at the pharmacy counter and see immediate relief.
A poll of more than 900 Connecticut residents that was sponsored by the Universal Healthcare Foundation of Connecticut found 88 percent of those who take their prescriptions regularly are worries they won’t be able to afford their medications. The poll also found 94 percent of respondents support authorizing the Attorney General to take legal action to prevent price gouging and 93 percent support improving price transparency.
“This is a very murky and shadowy pricing environment,” state Comptroller Kevin Lembo said Thursday.
Senate Republican President Len Fasano, R-North Haven, said they’ll be ready to take the bill up in the Senate if it passes the House.
Drug pricing and transparency has received bipartisan support in the past in the Senate. Fasano and Senate President Martin Looney, D-New Haven, have been working together closely in recent years on legislation aimed at lowering healthcare costs for consumers.
Sen. Ted Kennedy Jr., D-Branford, who isn’t seeking re-election, is trying to pass legislation that would require fully insured commercial insurance plans to offer a mental health screening as part of an annual physical exam.
The legislation, which unanimously passed the Insurance and Real Estate Committee, would also require health insurance carriers to report more data to the state so regulators can determine if there is any discrimination happening.
“True mental health parity has remained elusive, in part because of the miniscule size of the mental health provider networks that so many insurance companies offer Connecticut consumers,” Kenney said. “The plans don’t have enough providers to meet policyholders needs.”
However, the legislation does nothing to fix that problem.
“Many years ago we thought the federal government was going to address this issue,” Kennedy said. “Unfortunately, because of the developments that have taken place on the national stage a lot of these protections are now uncertain, so that’s why state’s like Connecticut are stepping up.”
He said this legislation doesn’t solve the entire problem, but it begins to chip away at it.
According to a Milliman study released in December 2017, Connecticut commercial policyholders were 10.5 times more likely to be sent out of network for mental health and behavioral services than for physical services.
Rep. Brenda Kupchick, R-Fairfield, said she focused on mental health treatment shortly after she was elected to her first term because it wasn’t long before she discovered how many of her constituents struggled with accessing services.
“Over and over again, I was told by so many people that they just couldn’t get services,” Kupchick said. “Their insurance company didn’t cover it. They couldn’t find doctors. They were running around in a maze of looking for help.”
She said “it’s very clear that they are still not getting parity.”
Kupchick said “it’s not as far as some of us would like to go,” but it’s sensible legislation that should be passed this year.
The Office of Fiscal Analysis said there may be a cost associated with the bill.
“The bill may result in a cost to the state employee and retiree health plan as well as fully insured municipal plans to the extent that the bill increases utilization of mental health screening services,” the Office of Fiscal Analysis fiscal note states.
A boost in mental health screenings may also increase premiums in 2019, but OFA was not able to make a prediction about how much they could increase.
At the same time, the bill “is not anticipated to result in a fiscal impact to the Insurance Department from expanded data collection, analysis and reporting requirements.”