The recently passed legislation is Ohio HB 479, a law which advocates for the disclosure of the drug price information to the patients. The law aims at increasing the transparency of the drug prices and lowering the prescription costs. The law will prohibit the gag rules that has been preventing the pharmacists from telling the patients the drug prices and cheaper options for acquiring the medications with the core aim of reducing medical costs which have been on the rise in America ( Stoddart & Evans, 2017 ). It concerns the pharmacy benefit managers, pharmacists and the disclosure of the drug prices to the patients in advance. The APN practice involves the provision of basic care that is focused on a specific population or a given health need and entails the ability to write prescriptions as well as the provision of family medicines. Ohio HB 479 will bring in changes in the practice of the APN practice including the revision of the formulary as well as prescription. This legislation will require the APN to provide the ideal care to the patients where innovative methodologies ought to be considered with regards to the disclosure of the drug price to the patients. It will involve measuring all the costs and outcome of the patients. Titled “disclose the drug information to the patients,” the legislation will impose restrictions on the PBMs regarding the costs of drugs and to ensure that patients in Ohio don’t pay any extra amount that they must for the medication they need.
Environment
Socio-cultural
Before the introduction of this legislation, the members of the society have been struggling with high medication costs that have affected the way they receive treatment. Many patients including cancer and chronic conditions patients have undergone a lot of challenges in dealing with the high medication costs, and this has led to poor health outcomes among the members of the community. Due to the lack of transparency from the pharmacy middlemen on the drug price, many patients have suffered from high costs of medication ( Barr, 2016 ). The PBMs have been charging customers high costs of medication, a cost that is higher than what they reimburse to the pharmacists and what a patient would have paid if they were paying for the drugs using cash other than their co-payments. As the Ohio pharmacists insist that their contract with the pharmacy-benefit managers in certain clauses ban them from telling the customers the drug price, they came out to support this legislation.
Delegate your assignment to our experts and they will do the rest.
Ethical
The ethical issue that has been arising before the introduction of this legislature was that the PBM were billing state higher medical costs than the amount they reimburse the pharmacists. Ethical issues arise when the PBMs charge patients who had insured a higher drug price compared to what they would be paying when they purchased these drugs from the pharmacy using cash other than the co-payments ( Schoonveld, 2016 ). It is unethical to charge patients high price in medication with the aim of making more profits at the time when the patients need medical help to improve their health outcomes. Transparency has been lacking in the drug pricing and prescription, a situation which has seen the prescription costs go high thus benefiting the PBMs at the expense of the patients. At the same time, the PBMs has a contract with the pharmacists which prohibit them from disclosing the drug price information to the customers or telling them a cheaper option for medication such as paying through cash. This results in the utilization of the patients by the PBMs, an act which amounts to unethical business practice. This is because charging higher prices than the normal to get higher profits is an immoral business practice. This led to legislators coming up with this legislation to prevent such unethical business practice.
Economic
The United States has experienced the ever-rising costs of health care over the last one decade. Compared to any other developed countries, America has the highest budget for health care coverage in the world. This high cost of arises from high medication prices as well as high costs of emergency services ( Collins et al., 2015). Allocating a huge budget to the healthcare sector leaves other sectors of the economy with insufficient budget allocation thus affecting economic development. At the same time, patients are forced to pay high costs of coverage with their respective insurers and this to affect their income levels and thus economic status. High costs of medication and prescription are one of the major causes of the ever-rising costs of health care. Failing to disclose the drug price information to the patients had led to PBMs taking advantage to exploit the customers by charging them higher prices than would be when they were paying using cash. Because the majority of the Americans are covered under Medicaid and Medicare, these inflated costs are incurred by the state and federal governments thus putting much pressure on the government resources ( Obama, 2016 ). The contract clause which prohibits pharmacists from telling the patients the drug price has led to the PBMs benefitting more by charging higher drug prices at the expense of the government and the taxpayers. This high cost is one of the things that led to legislators coming up with the bill
Political and Legislative
Political leaders and legislators have been under pressure to introduce laws that will increase efficiency and help reduce the cost of healthcare services. Because they are directly involved in the legislation process, it is the role of the legislators and other political leaders to help prevent the ever-rising costs of health care services. The drug price and prescription costs have been high due to failure to disclose the drug price information to the customers. This then called for the need to have them enact a law that will ensure the prescription costs are not high. As their mandate, the legislators and political leaders sponsored the bill and took it through many legislative processes until it became a law.
Progression of the Bill
The major sponsors of the Ohio HB 479 were representatives Scott Lipps and Thomas West. They were the primary sponsors of the bill who brought it before the house for debate. Other legislators who were the cosponsors of the bill included James Butler, Nino Vitale, Stephen Hambley, Ryan Smith, and Scott Wiggam. The list further included Eugene Miller, Michael Sheehy, Glenn Holmes, and Terry Johnson. The bill was voted unanimously voted after it was intruded in the house on January 24, 2018. After the legislators debated on the bill and the core sponsors Lipps and West tried to convince the members to support the bill, it was referred to the Government Accountability and Oversight Committee for further discussion. As the two core sponsors led in sponsoring the bill in the house, the other representatives signed on as the lead co-sponsors. After the bill stayed in the Government Accountability and Oversight Committee, it was reported out on May 22, 2018. The bill went through a voting process where it was passed unanimously by the representatives before being taken to the Senate for further analysis. The bill was passed on June 27, 2018, with all the members in the house supporting it. The main sponsors of the bill as well as the core sponsors played a key role in ensuring that the other representatives were influenced to support the bill that aimed at removing the barriers that existed between the pharmacists and the patients that had continuously added the cost of prescription of drugs.
The major stakeholder who first initiated this bill was the Ohio Pharmacists Association with the aim of preventing the Pharmacy Benefit Managers from imposing clawbacks and gag orders that prevent the pharmacists from providing the alternative drug pricing information to the patients. The legislation attracted a list of supporters from within the industry with many of them joining voice their concern over the importance of the legislation. The Academy of Medicine of Cleveland and Northern Ohio (AMCNO) is the leading regional physician organization representing the physicians in northern Ohio also, supported the legislation ( Shepherd, 2017 ). Others included the Alliance of Transparent and Affordable Prescription, American College of Rheumatology, Arthritis Foundation, Cleveland Clinic, and the Global Healthy Living Foundation. All these organizations took part in organizing and voicing their support for the legislation to be implemented. The legislation has also received more support lately with new stakeholders within the health department joining to voice their backing for the bill. These organizations include the Patients for Affordable Drugs, U.S. Pain Foundation and Ohio Pharmacists Association. They have all come out to support the prohibition of clawback orders and allow for the disclosure of drug price information to the patients with the aim of reducing the prescription costs.
The legislation also got support from the consumers of the healthcare products and services who feel that this will give them more options to decide whether to get the cheap drugs by cash from the pharmacists and reduce the costs of drug prescription. American Nurses Association have also supported the legislation saying it will help reduce the cost of drugs and reduce the overall healthcare costs while promoting quality.
After passing the bill in the house on June 27, 2018, it became law with immediate effect. After it became law, the legislation aims to achieve its goal which is to prohibit the PBMs from putting the clawbacks preventing the pharmacists from disclosing the drug price information to the patients ( Shepherd, 2017 ). Before it became law, the bill was introduced into the house by Lipps who is the Republican representative at Ohio house and West who is a Democrat representative at Ohio house. These two representatives introduced the bill on January 24, 2018, for debate amongst the house members. After discussion in the house, they referred the bill to the Government Accountability and Oversight Committee on January 30, 2018. The bill stayed at the oversight committee for three months before it was reported out on May 22, 2018, and taken back to the house for further debate and voting. On June 27, 2018, the bill passed after it unanimously got support from the representatives. While the bill was before the Government Accountability and Oversight Committee, ten witnesses including cancer patients, representatives of the national consumer groups and other stakeholders appeared before the committee to testify in support of the bill. On their part, Ohio Pharmacists claimed that the contract between them and the PBMs include certain clauses that ban them from telling the customers when the cash price for the drug is lower than the co-payments. The Ohio Department of Insurance demanded that PBMs should stop enforcing the gag rules and clawbacks which is a harmful and unethical business practice. The pharmacy benefit managers, on the other hand, argued that they negotiate for better prices from the drug makers and pharmacies as compared to the way consumers would do.
Effects of the Legislation
This legislation will have various effects on both the care providers and consumers. The positive effects of the legislation on the patients is that it will lead to reduced costs of prescription as well as the cost of drugs, a situation that will have an economic benefit to them in the long run. This is because by removing the clawbacks and prohibiting the PBMs from enforcing the gag rules, the patients will have the chance to decide whether to pay the drugs by cash or use co-payments, the one that they will deem cheap. PBMs will also be prevented from inflating the cost of drugs for the co-payments patients which has always led to high costs of medication to the patients. In the long run, the patients will experience positive health outcome due to reduced costs of medication. In the long term, stakeholders such as the Ohio Pharmacists Association will also benefit as they will no longer be prohibited from disclosing the drug price information to the patients so that they go for the cheaper option. At the same time, the Patients for Affordable Drugs, which is an organization that advocates for affordable drugs to consumers, will have its consumers get the drugs at an affordable price. This will improve the health outcome of the patients in the long run.
The negative impacts will, however, result for certain stakeholders such as the PBMs who will be forced to stop the gag rules and claw back business practice. The resulting outcome will be less revenue and thus reduced profits. This is because the law will prevent them from inflating the prices of the drugs to the levels that are above the price the consumers will get these drugs from the pharmacists at a cash price. In the long run, the PBMs will hence witness a reduction in their revenue and profitability.
The health care providers will also be affected by the legislation. The first group of the care providers who will be affected by the bill is the APN. These nurses are a concern with improving the healthcare outcome for the patient in a specific area and also take part in the prescription. The positive impact of the legislation on the care providers is that it will improve the way they deliver their services to the patients by helping them in the prescription of drugs that are affordable and best suits the condition of the patients. This will also allow them to disclose in advance the prices of the drugs to the patients so that they are aware of the cost of their medication. However, the health care providers will be accorded more responsibilities as they will have to assist the patients to understand the cost of their medication and what they will be required to pay. This will, in the long run, lead to a strong relationship and more trust between the care providers and the patients, an aspect that is beneficial in increasing the health outcome of the patients. The negative impact is that the legislation will change the responsibilities of the care providers by making them get involved in the drug costs as well as the care, a situation that could negatively impact their ability to provide the best care services for patients.
Policy Comparison
Colorado State has legislation known as HB 18-1284 concerning the cost of prescription of drugs purchased at the pharmacy. This states that consumers have the right to know about the options that they have to reduce the amount of money they spend on drugs ( Sawicki, 2016 ). It, therefore, requires the pharmacists to disclose information concerning the cost of prescription of drugs. It goes to state that a carrier or a pharmacy benefit manager acting on behalf of the carrier shall not prohibit the pharmacist from disclosing to the patients the information concerning the most affordable alternatives that will make them spend less on drugs. A carrier or a PMBs shall not, therefore, penalize a pharmacist for having disclosed information concerning the price of the drug and available alternatives ( Eichler et al., 2015). The legislation also states that a carrier or a PMBs shall not require a pharmacist to collect co-payments from a covered person that is more than the charges required. Compared to the Ohio HB 479, these two legislations are similar. They both aim to stop gag rules which prohibit pharmacists from disclosing the drug price information to the patient. Also, both the two legislations aim at ending claw back by prohibiting the PMBs from inflating higher drug costs for covered patients.
Options
The two options that can be used to improve policy outcomes include the establishment of drug price monitoring agency and forming a collaboration with all the stakeholders within the health department. The drug price monitoring agency can be constituted with the key responsibility of monitoring the prices of drugs and how pharmacists charge patients for co-payments option. Constant inspection and surveillance are essential in ensuring that the policy is taken effectively implemented and the outcome becomes successful ( Brazier & Cave, 2016 ). Forming a collaboration with all the stakeholders within the health department can help ensure that there effective monitoring of the cost of drugs. Stakeholders from all areas, both private and government can work together towards this goal and ensure that patients do not pay more and that they get access to the information that provides a better alternative for purchasing drugs.
References
Barr, D. A. (2016). Introduction to US Health Policy: the organization, financing, and delivery of health care in America . JHU Press.
Brazier, M., & Cave, E. (2016). Medicine, patients,and the law . Oxford University Press.
Collins, S. R., Rasmussen, P. W., Doty, M. M., & Beutel, S. (2015). The rise in health care coverage and affordability since health reform took effect. New York: The Commonwealth Fund.
Eichler, H. G., Hurts, H., Broich, K., & Rasi, G. (2016). Drug regulation and pricing—can regulators influence affordability?. New England Journal of Medicine , 374 (19), 1807-1809.
Obama, B. (2016). The United States health care reform: progress to date and next steps. Jama, 316(5), 525-532.
Obama, B. (2016). The United States health care reform: progress to date and next steps. Jama , 316 (5), 525-532.
Sawicki, N. N. (2016). Mandating Disclosure of Conscience-Based Limitations on Medical Practice. American journal of law & medicine , 42 (1), 85-128.
Schoonveld, E. (2016). The price of global health: drug pricing strategies to balance patient access and the funding of innovation . Routledge.
Shepherd, J. (2017). The Prescription for Rising Drug Prices: Competition or Price Controls. Health Matrix , 27 , 315.
Stoddart, G. L., & Evans, R. G. (2017). Producing health, consuming health care. In Why are some people healthy and others not? (pp. 27-64). Routledge.
