CVS Health has asked Gov. Phil Scott to veto H.353 — a last-ditch effort to block a bill it says would raise prescription drug costs for Vermonters with private insurance.
H.353 started out as a bill to make drugs more affordable by regulating pharmacy benefits managers, third-party companies that negotiate medication coverage plans for consumers with private insurers. But revisions of the bill, as it worked its way through the House and Senate, would have all but guaranteed that specialty drug prescriptions given to patients in health care settings, including expensive cancer medication, would be filled at the University of Vermont Health Network’s pharmacy in Burlington, rather than through cheaper mail-order pharmacies that insurers prefer.
Though the language was softened somewhat in subsequent revisions, the final version of the bill, approved Wednesday in the dwindling hours of this year’s legislative session, still gives UVM Health Network an advantage when it comes to filling those expensive prescriptions.
In its letter to the Scott administration Friday, CVS Health said the bill “enshrines a special arrangement that allows hospitals to mark up specialty medication prices for patients with rare and complex conditions.”
Jason Maulucci, Gov. Phil Scott’s press secretary said the governor has yet to make a decision on the matter.
“We support the goals of bringing down costs for consumers, but we have not received the bill yet, and once we do, it will go through our thorough review process before the Governor decides,” Maulucci wrote in an email.
CVS Health has a pharmacy benefits management company that does business in Vermont. The company argued that H.353 would cost individual patients hundreds of dollars a year.
Jeff Hochberg, president of Vermont Retail Druggists, said CVS Health’s concerns are unfounded. According to Hochberg, the bill simply redirects prescription money from pharmacy benefit management companies to local pharmacies. Patients, he said, would not see an increase in their premiums as a result.
“Ciphering money out of state to three publicly traded companies does nothing but maintain the steady upward pressure on pharmaceutical costs,” Hochberg said.
Specialty prescriptions — a broad category that includes anything from Botox to biological drugs — are a relatively new addition to a doctor’s arsenal. Patients typically get these drugs at a clinic or other health care setting through a monthly infusion or injection. Because these drugs can cost thousands of dollars for one dose, insurers dispense them sparingly and only after patients and their doctors have exhausted all other options.
The bill could be a financial boon to UVM Health Network. A single dose of Herceptin, a biological drug to treat esophageal and breast cancers, for example, costs more than $10,000 when dispensed at a hospital pharmacy, according to national insurer trade group AHIP. The same drug costs roughly $6,500 at a physician’s office and $4,600 at a standalone pharmacy.
Private insurers countered that the legislation would force them to pay for more drugs to be dispensed at the only commercial specialty pharmacy in the state, UVM Health Network’s pharmacy in Burlington.
A UVM Health Network spokesperson was not immediately available to comment
Significantly, the bill would allow the state’s Medicaid program to source and ship specialty drugs by mail through Rutland Pharmacy, the only specialty pharmacy that works with this public insurer.
Rep. Mari Cordes, D/P-Lincoln, who sponsored the bill in the House, previously said that she’d like to change the part of the bill that gives UVM Health Network an advantage when it comes to specialty drugs.
Cordes was not immediately available for comment Friday morning.
