Will Massachusetts Wrestle Down Drug Prices?

I’ve begun taking eye drops for possible glaucoma, and each morning, I try to hit the mark to avoid medicine running down my face.

Then I read the ProPublica exposé about drug companies engineering waste into their products — including glaucoma drops “larger than the human eye can hold” — so you have to buy more.

Now I’ll probably need meds to keep my blood pressure from spiking over this scam. Don’t business schools teach PR anymore? With all the controversy surrounding our runaway drug prices, you’d think public outrage over deliberately designed waste would be the last thing pharmaceutical companies would want. (Pending legislation would order federal agencies to halt this abuse.)

Not just drugs but all of America’s health care is overpriced. Yet drug prices are an area in which Massachusetts has a plan that may make it, again, the nation’s teacher on health care, as it was when its insurance reform inspired Obamacare.

The state’s “really big idea to bring down drug costs,” as Vox headlined it, wouldn’t regulate the size of my eye drops. But it would give Massachusetts's Medicaid program greater leeway in rejecting drugs that it covers, authority that private insurers now wield.

Currently, Medicaid, the joint federal-state health program for the poor, covers any drugs approved by the FDA and whose makers participate in Medicaid’s federal drug rebate program. The theory behind the Massachusetts plan, which needs permission from the Trump administration to proceed, is that drug-rejection authority would give the state more bargaining power with drug makers. It could demand cheaper prices in exchange for green-lighting pharmaceuticals.

“A private insurer has broad discretion to decide which drugs to cover,” Vox notes. “If there are two drugs for your high blood pressure that more or less do the same thing and do an equally good job of keeping your hypertension under control, the plan can say, you know what, we are only going to cover the $10 drug.”

The state couldn’t willy-nilly reject vitally needed drugs just to save money. Vox says the plan would require Medicaid coverage of at least one drug for any condition, and there would be wiggle room; if an approved drug induced side effects in a patient, she’d be allowed to try an alternative.

Massachusetts officials vow, however, not to approve new drugs absent compelling evidence, at least to state regulators, of their effectiveness, according to Vox.

Trump and Republican leaders are notoriously allergic to government regulation, even though no nation on earth has controlled medical costs without it. In particular, Singapore’s government, whose health system conservatives tout, rigorously polices approval of effective drugs for public subsidies.

But the GOP at least pays lip service to states’ autonomy, even if it doesn’t always walk the walk. States, Justice Louis Brandeis famously said, are “laboratories” of democracy, and they’ve performed valuable experiments with health coverage, from Romneycare to Maryland’s hospital regulation, which might have saved the nation trillions had it been implemented nationally.

In a 26-pages-plus-appendices request to the feds, Daniel Tsai, assistant secretary of the Massachusetts program that includes Medicaid, wrote that state spending on drugs has risen 13 percent annually since 2010, threatening to “crowd out important spending on health care and other critical programs.”

Meanwhile, congressional Democrats, seeking to rectify a Republican French kiss to drug companies, have filed a bill that would allow Medicare, the federal health program for seniors, to negotiate discounts with pharmaceutical firms. Trump spoke favorably of the idea while campaigning last year.

But Trump also campaigned on a better health plan than Obamacare. We saw how that worked out. And his administration rebuffed sponsors’ attempts to discuss the legislation with the president.

Juggling Massachusetts’s waiver request, Medicare reform and his tax plan all at once, Trump sadly may prioritize that last, faulty one, and drop the balls that might begin getting drug prices under control.