Home · Health · Sep 14 archive
Bill Aims to Cut Costs of Autoimmune Disease Drugs
Confirmed
In Short: A new California bill seeks to reduce the cost of expensive biologic drugs for autoimmune diseases by switching patients to cheaper biosimilars.
High-cost drugs, especially specialty drugs like biologics, serve a very small percentage of the overall population," said Weber Pierson, a senator who crafted the bill. "My goal was for patients to see immediate savings, but I believe consumers may still feel the difference over time.
In a report last year, the state’s Department of Managed Health Care found that while specialty drugs, including biologics, accounted for less than 2% of all prescriptions, they accounted for 63% of total annual prescription drug spending. Insurers already require patients to try cheaper alternatives before approving coverage for biologics.
Some of my patients have already been forced to switch to biosimilars when insurers drop brand name biologics from the list of drugs they cover," said Dore, past president of the California Rheumatology Alliance. "This bill would give doctors and patients 60 days’ notice before switching a medication, allowing them to plan and weigh in.
If switching to a biosimilar doesn’t work out for a patient, they would be allowed to go back to the original drug, according to Weber Pierson. The bill also requires health insurance plans to notify doctors and patients 60 days in advance of any medication switch.
What's confirmed
- High-cost drugs, especially specialty drugs like biologics, serve a very small percentage of the overall population," said Weber Pierson, a senator who crafted the bill. "My goal was for patients to see immediate savings, but I believe consumers may still feel the difference over time.
- In a report last year, the state’s Department of Managed Health Care found that while specialty drugs, including biologics, accounted for less than 2% of all prescriptions, they accounted for 63% of total annual prescription drug spending. Insurers already require patients to try cheaper alternatives before approving coverage for biologics.
- Some of my patients have already been forced to switch to biosimilars when insurers drop brand name biologics from the list of drugs they cover," said Dore, past president of the California Rheumatology Alliance. "This bill would give doctors and patients 60 days’ notice before switching a medication, allowing them to plan and weigh in.
- If switching to a biosimilar doesn’t work out for a patient, they would be allowed to go back to the original drug, according to Weber Pierson. The bill also requires health insurance plans to notify doctors and patients 60 days in advance of any medication switch.
What's still developing
- According to a legislative analysis, this bill could reduce premiums paid by employers, enrollees and government by about $87.7 million a year — a cut of less than 1%.
- The state is going after hospitals that overspend, has pulled back on covering weight-loss drugs, and has started to sell insulin at a fraction of the market price.
- Liz Helms, president of the California Chronic Care Coalition, said she understands the need to control health costs — it’s top of mind for many patients.
- Weber Pierson, who is also an obstetrician, crafted the bill as a cost-cutting measure as prescription drugs become a growing pain point in healthcare costs.
- We believe that patients should have access to innovative medicines.
- Our mission is to conduct effective advocacy for public policies that encourage the discovery of important, new medicines for patients by biopharmaceutical research companies.