By Lindsay Street, Statehouse correspondent | A pharmacist in South Carolina can be penalized for telling a patient that paying cash for his or her drugs may be cheaper than the copay.
That will change starting in 2021 as South Carolina has joined the majority of states looking to curb the high cost of life-saving medicines like insulin. The state Department of Insurance will begin regulating drug administrators for health plans, but advocates say more work can be done in the Palmetto State.
“The issue of prescription drug costs is that they have gone up so much that people literally cannot afford to get their prescriptions,” AARP State Director Teresa Arnold told Statehouse Report.
Craig Burridge, CEO of S.C. Pharmacy Association, said South Carolina is caught up in a national crisis.
Whether any additional measures will be considered by lawmakers is hard to tell. Several Republicans who work on medical affairs and budgets related to Medicaid and employee plans did not return phone calls seeking comment.
But House Medical, Military, Public and Municipal Affairs Committee Chair Leon Howard, D-Richland, said that while lowering prescription “is very important” and he is supportive of lowering prescription drug costs, he was not aware of any pending legislation for the 2020 session.
“South Carolina is in a health care crisis as it relates to prescription drugs,” Howard said. He added that he is working toward other initiatives that could help offset other expenses, especially for seniors. “I want to work toward seniors never have to choose between something and their medicine.”
In the works
Gov. Henry McMaster this year signed into law a measure that prohibits pharmacy benefits managers from penalizing pharmacists who tell patients about lower-cost options.
Burridge described pharmacy benefits managers as “middle men.” The American Pharmacists Association says the managers are “primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.”
The S.C. Department of Insurance will work to develop a regulatory framework prior to implementation in 2021. Director Ray Farmer said the agency is formulating a plan for regulating the sector. He said it is the first time the state will regulate pharmacy benefits managers.
Burridge said this is a step in the right direction.
“At least there is someone they have to answer to now,” Burridge said. “And now the pharmacists can educate the patient without being thrown out of the network.”
- INSIDER TIP: Want to save on prescription drugs now? S.C. Pharmacy Association CEO Craig Burridge said to ask your pharmacist if there is a cheaper option.
Managers have been fingered by pharmacists and lawmakers as a primary cause of rising drug costs. More than 30 states nationwide have enacted laws prohibiting managers from preventing disclosure of lower-cost options by pharmacists. The Trump administration has also set pharmacy benefits managers in its sights, but only for Medicaid and Medicare drug prices, not in the private sector.
The 2019 law in South Carolina marks the second time in a decade that state lawmakers have sought to rein in pharmacy benefits managers. In 2013, lawmakers set up an appeals process for pharmacies undergoing an audit at the behest of benefits managers.
In the last few years, the state’s benefits plan and Medicaid have also pushed for more transparency through contracts with the managers, Burridge said.
Beyond implementing the current law, Farmer said his agency may have recommendations at some point on drug costs “but we’re not there yet.”
Burridge said the state needs to let the current pharmacy benefit manager legislation get “fully implemented” before looking at other measures. He also said focusing pharmacy benefits managers is the right call, but other states have done more. Nonprofits like AARP say more action is needed.
While AARP pushes regulation and transparency for pharmacy benefits managers, Arnold said that thinking such managers were the root of the problem “would stretch the imagination.”
Importing from Canada
AARP is pushing prescription drug costs to be a part of the 2020 presidential election cycle conversation. But the advocacy group for seniors is also looking at state and congressional measures.
One policy step the group says could work — and has been passed in other states — is importing drugs from foreign nations that follow similar drug regulations to the United States. Florida Gov. Ron DeSantis recently signed a bill into law that would allow the state to import prescription drugs from Canada.
Arnold said her group is planning to meet with South Carolina lawmakers prior to the start of the 2020 session on similar legislation.
“It won’t just save South Carolina citizens’ lives. It will reduce costs in our budget because the state pays for drugs through the state health plan, through (Department of) Corrections and through Medicaid,” she said.
Burridge questioned the safety of such imports.
Other actions being pushed by AARP:
- Enacting rate ceilings for brand-name drugs. Bills have been introduced in 14 states this year; and,
- Leveraging buying power of the state by pushing bulk purchasing for state-run healthcare. So far, California is the only state working on a proposal using bulk purchasing.
“There’s such a bipartisan desire now to see the drug prices lower,” Arnold said. “It is going to have to occur in state legislatures and in Congress and with the president.”
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