On July 24, 2024, the Oregon Prescription Drug Affordability Board (PDAB) held seven panels related to upper payment limits (UPLs), with each panel addressing 1-2 key questions from the Board.
- The first panel focused on patients and consumers, with a patient sharing his experience with high out-of-pocket costs and highlighting duplicative expenses in healthcare.
- The second panel involved Pharmacy Benefit Managers (PBMs). When asked about the data needed to ensure pass-through savings at the point of sale, PBMs expressed concerns about losing negotiation leverage due to rebate pass-through requirements.
- The third panel comprised insurers, who discussed the prevalence of carve-outs, AFPs, and point-of-sale discount strategies. They noted that practices vary by plan and raised concerns about the impact of UPLs on interstate commerce and accountability.
- The fourth panel included manufacturers, who addressed questions about the protections required for sharing trade secrets and the definition of affordability. They suggested statutory exemptions from public disclosures to protect trade secrets and expressed concerns about the impact of UPLs on trade secrets and generic competition, emphasizing the need to consider both costs and value in defining affordability.
- The fifth panel featured advocacy groups, who warned about potential negative impacts on drug availability and affordability for patients, stressing the importance of addressing rare diseases. They suggested learning from other states and federal experiences, as well as focusing on broader systemic issues relating to affordability.
- The sixth panel focused on pharmacies, which were asked about alternative solutions like drug importation and suggestions for UPL model considerations. They expressed concerns about reimbursement challenges and the impact on patient costs, emphasizing the need to include pharmacies in the process and set up guardrails. They also suggested that UPL models should also focus on sustainability for pharmacies in Oregon.
- The seventh panel included hospitals, federally qualified health centers, and providers, who provided suggestions for the UPL-setting process and advice on avoiding unintended consequences. They were concerned about the impact of UPLs on the 340B program and drug access, emphasizing the importance of maintaining margins to support vulnerable patients and community reinvestments. They recommended excluding drugs purchased through 340B from UPLs to avoid negative impacts on reimbursement and access.
Ultimately, the meeting highlighted diverse perspectives on UPLs, with significant concerns about the potential negative impacts on drug pricing, access, the feasibility of sustaining this type of program and the broader systemic issues related to prescription drug affordability.
Last Updated on July 25, 2024 by Aimed Alliance
